Family Nurse Practitioner Exam

What is the most likely diagnosis for a 28-year-old pregnant woman experiencing bright red vaginal bleeding at 32 weeks gestation?

1. Placenta abruptio

2. Placenta previa

3. Acute cervicitis

4. Molar pregnancy (hydatidiform mole)

The correct answer is: Placenta previa

The most likely diagnosis in this scenario is placenta previa. This condition is characterized by the placental tissue covering the cervical opening, causing bright red vaginal bleeding, particularly later in pregnancy. The bleeding that occurs in cases of placenta previa is often painless and can be significant, which aligns with the symptoms described in the scenario. In this case, timing is critical; since the woman is at 32 weeks of gestation, bleeding due to placenta previa can escalate as the pregnancy progresses, leading to increased risk for both the mother and the fetus. A definitive ultrasound can usually confirm the diagnosis of placenta previa by revealing the position of the placenta in relation to the cervix. The other conditions listed present differently or are associated with different patterns of bleeding. For instance, placental abruption involves the premature separation of the placenta from the uterine wall, and while it can also cause bleeding, this bleeding is typically accompanied by abdominal pain or contractions, which is not mentioned here. Acute cervicitis might cause vaginal bleeding as well but usually occurs with other symptoms such as pelvic pain or unusual discharge. Molar pregnancy, while it can lead to bleeding, usually presents with other symptoms like excessive nausea or a larger-than-expected uterus. Therefore, given the specific presentation