By the end of this oral boards case, the learner will be able to: 1. List the potential causes of vaginal bleeding in pregnancy after 20 weeks including placental abruption, placenta previa and vasa previa. 2. Describe the bedside stabilization and evaluation in a pregnant patient with vaginal bleeding after 20 weeks. a) Stabilize the mother (patient) including placing two large bore intravenous (IV) lines, administer an IV fluid bolus, obtaining complete blood count (CBC), coagulation studies, and type & cross matching blood. b) Transvaginal ultrasound to determine the placental location. c) Sterile speculum examination. A digital or speculum pelvic examination should NOT be performed until a transvaginal ultrasound is performed to determine placental location. The resident should understand that performing a digital or speculum exam in a patient with placenta previa or vasa previa can cause or exacerbate hemorrhage. If these two conditions are not present on ultrasound, then a sterile speculum exam may be performed to further examine the bleeding. 3. Contrast the typical presentation of placenta previa with that of placental abruption. a) Placenta Previa usually causes painless vaginal bleeding. Part of the placenta is located near or over the internal cervical orifice. b) Placental Abruption usually causes painful vaginal bleeding. There is premature separation of the placenta from the uterine lining. 4) Describe the appropriate disposition of a patient with a pregnancy over 20 weeks with vaginal bleeding. After initial workup and stabilization these women are usually admitted for fetal monitoring, observation and consultation by the obstetrician (OB/gyn).