A 28-week pregnant patient with bright red vaginal bleeding and no uterine contractions should be instructed to which of the following?

• A. Lie on your left side for about one hour and see if the bleeding stops.
• B. Come to the clinic today for an ultrasound.
• C. Bring a urine specimen to the lab tomorrow to determine if you have a urinary tract infection.
• D. Go immediately to the emergency room.

Answer: (B)

Painless vaginal bleeding at mid-pregnancy points to placenta previa until proven otherwise, so immediate imaging to locate the placenta is essential. The best next step is to come in today for an ultrasound to determine where the placenta sits in relation to the cervix and to guide safe management. An ultrasound directly shows placental position, helps decide whether a vaginal exam is safe, and plans monitoring or delivery strategy as pregnancy progresses. Waiting at home or addressing unrelated issues won’t clarify the cause of the bleeding, and going to the emergency department is only necessary if bleeding is heavy or the patient becomes unstable. A urine test to check for a urinary tract infection wouldn’t address the bleeding source.