A primigravida at 36 weeks presents with sudden painless bright red bleeding, no uterine contractions, and a soft non-tender uterus. Fetal heart rate is normal. The most appropriate immediate investigation is:

• A Digital vaginal examination to assess cervix
• B Emergency caesarean section without further investigation
• C Speculum examination followed by Kleihauer-Betke test
• D Ultrasound examination to determine placental location ✓

Explanation

The clinical picture of painless antepartum haemorrhage with a soft uterus is characteristic of placenta praevia until proven otherwise. The critical first step is ultrasound to confirm placental location before any digital vaginal examination, which is absolutely contraindicated in placenta praevia as it can provoke catastrophic haemorrhage. Speculum examination may follow once praevia is excluded.

Reference: Williams Obstetrics, 26th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.