A 30-year-old G3P2 at 28 weeks with a previous classical cesarean section presents with painless bright-red antepartum bleeding. Ultrasound shows placenta anterior and covering the internal os with absence of the normal retroplacental clear space. What is the MOST likely diagnosis?

• A Vasa previa
• B Abruptio placentae
• C Placental abruption with marginal sinus rupture
• D Placenta previa with accreta spectrum ✓

Explanation

The combination of anterior low-lying placenta, prior classical (vertical) uterine incision, loss of the retroplacental clear space, and painless bleeding strongly suggests placenta previa with placenta accreta spectrum (PAS). Classical incision scars predispose to PAS more than lower-segment scars. Vasa previa presents with fetal vessel bleeding at rupture of membranes; abruption is painful with retroplacental clot.

Reference: Williams Obstetrics, 26th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.