Which sign may indicate placenta previa in an unbooked woman arriving at a secondary unit?

Painless bleeding is a classic sign of placenta previa, a condition where the placenta implants over or near the cervix, which can lead to significant complications during pregnancy and delivery. In an unbooked woman, who has not received regular prenatal care, the lack of prior assessment makes it crucial to identify this symptom.

The painless characteristic of the bleeding is particularly important, as it differentiates it from other potential causes of bleeding in pregnancy, such as placental abruption, which typically causes pain. The presence of painless bleeding may indicate that the placenta is obstructing the normal pathway for delivery, leading to the risk of hemorrhage for both the mother and the fetus.

This understanding emphasizes the need for immediate medical evaluation in such cases to ensure the safety of both the woman and her baby. The other signs mentioned, such as moderate abdominal pain or increased fetal movement, do not specifically indicate placenta previa and are not traditionally associated with this condition. High energy levels also do not correlate with any indication of complications related to the placenta, further supporting why painless bleeding is the critical sign to watch for in this scenario.