All are true about placenta pre EXCEPT:

Increased uterine tone REF: Current Diagnosis & Treatment Obstetrics & Gynecology, 10th edition Chapter 20 Placenta Pre Essentials of Diagnosis Spotting during first and second trimesters. Sudden, painless, profuse bleeding (bright red, clotted blood) in third trimester. Initial cramping in 10% of cases. Abruptio placenta Placenta pre History * Frequent association of preeclampsia * No association with preeclampsia or hypeension from any cause * Repeated warning hemorrhages often * A single attack of vaginal bleeding, which usually continues until delivery * occurring over a period of weeks Usually no abdominal pain * Abdominal pain Abdominal Examination * Local uterine tenderness, hypeonic "woody" uterus in a concealed * Normal uterine tone and usually no tenderness abruption * Patient rarely in labor * * patient usually in labor Presenting pa often engaged * Presenting pa above brim, malpresentation usually found * Presenting pa maybe difficult to * Fetal pas usually palpable palpate * Fetal hea sounds usually present * Fetal hea sounds often absent Ancillary aids * placenta demonstrated in upper uterine segment by ultrasound * Placenta demonstrated in lower uterine segment by ultrasound Vaginal examination * Double set-up reveals no placenta within 5 cm of internal os * Double set-up reveals placenta implanted in the lower uterine segment