A 32-year-old female who is 34 weeks pregnant complains of heavy vaginal bleeding. She denies pain or recent trauma. You should suspect?

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Painless vaginal bleeding in the third trimester is most consistent with placenta previa. When the placenta implants low in the uterus near or over the cervical opening, bleeding can occur as the cervix begins to dilate or with minor placental shedding, and it typically presents without uterine tenderness or contractions. This contrasts with placental abruption, which usually causes sudden, painful bleeding with a tender, rigid uterus; ectopic pregnancy presents earlier in pregnancy with abdominal pain and often shock risk; and uterine rupture tends to present with severe abdominal pain, fetal distress, and a highly tender or changing uterus, typically during labor or after prior uterine surgery. Therefore, at 34 weeks with heavy, painless bleeding, placenta previa is the most likely diagnosis. Confirm with ultrasound to locate the placenta, avoid vaginal examination until placental position is known, and plan management around maternal and fetal status, often involving cesarean delivery if the previa persists or bleeding is significant.