A 28-year-old G2P1 at 34 weeks presents with sudden painless bright red vaginal bleeding. Ultrasound shows a complete placenta previa. There is no uterine tenderness and fetal heart rate is 145 bpm. The most appropriate immediate management is:
- A Emergency cesarean section immediately
- B Vaginal examination to assess cervical dilation
- C Admit, stabilise, and plan for elective cesarean at 36–37 weeks if bleeding stops ✓
- D Prostaglandin induction for expedited delivery
Correct answer: C. Admit, stabilise, and plan for elective cesarean at 36–37 weeks if bleeding stops
Explanation
For a hemodynamically stable patient with a sentinel bleed from placenta previa at 34 weeks, conservative (expectant) management is indicated: hospitalization, IV access, blood grouping and cross-matching, and corticosteroids for fetal lung maturity. Planned cesarean is typically at 36–37 weeks for complete previa, or earlier if severe hemorrhage or fetal compromise occurs. Digital vaginal examination is absolutely contraindicated in placenta previa as it can precipitate catastrophic hemorrhage. Prostaglandins are contraindicated.
Reference: Williams Obstetrics, 26th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.