Rosh Women's Health Practice Exam

The best next step in evaluating a patient with painless vaginal bleeding at 30 weeks of pregnancy is to perform a transvaginal ultrasound. This imaging technique is highly effective in assessing the condition of the placenta and can help determine the location of the placenta, which is crucial in cases of bleeding during pregnancy.

At 30 weeks of gestation, concerns such as placenta previa or placental abruption may arise, and a transvaginal ultrasound can provide clear images that allow for accurate assessment of these conditions. It is particularly useful for evaluating placental status because it can detect the positioning relative to the cervix, which is not as clearly visible with other techniques.

Additionally, a transvaginal ultrasound typically offers better resolution for pelvic structures when compared to an abdominal ultrasound, especially in scenarios involving bleeding. While abdominal ultrasounds can provide some information, the immediate and more detailed evaluation needed for bleeding warrants the transvaginal approach.

Other options like a bimanual exam or a speculum exam may be relevant in certain contexts of obstetric care, but they do not provide the definitive imaging needed to assess the risk factors associated with the bleeding in this case. Instead, they may primarily be used for first-line assessments or specific situations rather than