A woman with a low-lying placenta diagnosed at 32 weeks undergoes transabdominal and transvaginal sonography at 36 weeks. The lower placental edge lies 25 mm from the internal cervical os. There is no vaginal bleeding. The most appropriate plan for delivery is:

• A Elective cesarean section at 37 weeks
• B Planned vaginal delivery with facilities for emergency cesarean ✓
• C MRI-guided assessment before deciding route
• D Cesarean section only if bleeding occurs in labor

Explanation

When the placental edge is more than 20 mm from the internal os at term, vaginal delivery can be safely attempted with standby arrangements for cesarean, since clinically significant bleeding is unlikely. A distance of less than 20 mm generally favors cesarean. MRI adds nothing for simple distance measurement, and waiting for bleeding before planning the route abandons the purpose of antenatal mapping.

Reference: RCOG Green-top Guideline No. 27a, Placenta Praevia and Placenta Accreta Spectrum ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.