A 32-week pregnant client presents to the emergency department with vaginal bleeding. The client reports slight vaginal bleeding at 29 weeks, which resolved spontaneously, and now has a recent onset of bright red vaginal bleeding. There are no uterine contractions, the fetal heart rate is within normal range, and the uterus is soft and non-tender. Based on the assessment findings, which condition would the nurse likely suspect?
Explanation & Rationale
A. Preterm labor: Preterm labor typically presents with regular uterine contractions, cervical changes, and possibly mild bleeding. This client has no contractions or uterine activity, making preterm labor less likely in this scenario. B. Placenta previa: Placenta previa is characterized by painless, bright red vaginal bleeding in the second or third trimester. The absence of contractions and a soft, non-tender uterus are consistent with this condition. The history of bleeding at 29 weeks further supports this suspicion. C. Placental abruption: Placental abruption usually presents with painful vaginal bleeding, a firm or tender uterus, and sometimes fetal distress. The lack of uterine tenderness or contractions makes abruption less likely in this case. D. Vasa previa: Vasa previa involves fetal blood vessels crossing the cervical os and is typically associated with membrane rupture and rapid fetal deterioration. The fetal heart rate is normal, and there’s no mention of ruptured membranes, which makes this diagnosis unlikely.