In the scenario of third-trimester vaginal bleeding without abdominal pain, what is an appropriate initial assessment?

• A. Immediate cesarean.
• B. Assess the fetal heart rate.
• C. Administer pain medication.
• D. Perform pelvic exam.

Answer: (B)

Assessing the fetal status right away is the priority. Checking the fetal heart rate gives immediate, crucial information about whether the fetus is tolerating the intrauterine environment and helps guide next steps. In late-pregnancy vaginal bleeding without pain, placenta previa is a key concern, so confirming fetal well-being first also avoids doing a pelvic exam that could worsen bleeding if the placenta is low-lying. A reassuring fetal heart tracing supports proceeding with ultrasound to locate the placenta and plan management; nonreassuring tracing or ongoing bleeding would escalate care toward delivery. Pain relief doesn’t address the bleeding risk, and immediate cesarean is reserved for fetal distress or confirmed clinically significant placenta previa with bleeding, not as the initial step.