Vaginal bleeding in a pregnant 32-year-old woman

• Medical history: Asthma with no recent exacerbations. No history of bleeding disorder.


• Surgical history: None


• Obstetric history: Menarche at age 12 years. One first-trimester miscarriage 6 years prior. One uncomplicated full-term vaginal delivery of a healthy 7.5-pound female infant 3 years prior. Patient has received all her prenatal care at another facility and her records are unavailable.


• Medications: Prenatal vitamin, albuterol as needed.


• Allergies: None


• Family history: Noncontributory


• Social history: Smokes 2 cigarettes a day, down from half a pack a day at the beginning of pregnancy. She denies alcohol and drug use. She lives at home with her fiancé and her daughter. She is employed as a security guard at a local college.