Abnormal implantation of the placenta near or over the cervix?

• A. Placenta Previa
• B. Pelvic Inflammatory Disease (PID)
• C. Renal Calculi
• D. Sickle Cell Anemia

Answer: (A)

Placenta previa is when the placenta implants low in the uterus, near or over the cervical opening. That location means the placenta can be disrupted or bleed as the cervix dilates, leading to vaginal bleeding late in pregnancy. The hallmark feature is painless vaginal bleeding in the latter part of pregnancy, often with a soft, non-tender uterus. In EMS, suspect placenta previa in a pregnant patient with sudden vaginal bleeding without painful contractions or uterine tenderness, especially in the third trimester. Avoid vaginal exams if previa is suspected and focus on stabilizing the patient: place her on her left side to improve blood flow, administer oxygen if needed, establish IV access, and transport to a facility with obstetric capability for evaluation and potential delivery by cesarean section if required. The other conditions listed are not related to placental placement: pelvic inflammatory disease is an infection causing pelvic pain and discharge; renal calculi cause intense flank or groin pain and possibly blood in the urine; sickle cell disease involves systemic vaso-occlusive pain and other complications, not placental implantation.