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EM@3AM: Placenta Previa

A 37-year-old G4P3003 female at 27 weeks GA presents via EMS for vaginal bleeding. She began having brisk vaginal bleeding after coitus about 30 minutes ago and has saturated 1 pad since onset. She denies associated abdominal pain, cramping, or prior episodes of vaginal bleeding during this pregnancy. On exam, her abdomen is gravid, soft, and non-tender. On external pelvic exam, she has no visible lesions, and the maternal pad she is sitting on is about 50% saturated with blood. What’s the diagnosis? What’s the next step in your evaluation and treatment?