A 28-year-old G2P1 at 36 weeks presents with sudden painless bright red vaginal bleeding. Ultrasound shows the placenta completely covering the internal os. Fetal heart rate is reactive. What is the MOST critical contraindication to management in this patient?

• A Tocolysis with nifedipine
• B Administration of betamethasone for fetal lung maturity
• C Hospitalization and bed rest
• D Digital vaginal examination ✓

Explanation

In complete placenta previa, digital vaginal examination is absolutely contraindicated as it can precipitate massive hemorrhage by disrupting the placenta overlying the internal os. Management includes hospitalization, IV access, crossmatch, and betamethasone if <34 weeks. Tocolysis may be used cautiously if preterm contractions are present. Delivery is planned by cesarean section.

Reference: Williams Obstetrics, 26th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.