A 30-year-old primigravida at 37 weeks has an ultrasound showing the lower placental edge lying 15 mm from the internal os, with no bleeding episode so far. There are no other indications for operative delivery. What is the recommended route of delivery?

• A Induction of labor with a Foley catheter at 38 weeks
• B Spontaneous onset of labor with vaginal delivery permitted
• C Immediate cesarean section now regardless of gestational age
• D Elective cesarean section at 39 weeks ✓

Explanation

When the placental edge lies less than 20 mm from the internal os in the third trimester, vaginal delivery carries unacceptable hemorrhage risk, so planned cesarean section is recommended. D distance of 20 mm or more allows consideration of vaginal birth. Induction with a Foley catheter or any trial of labor is inappropriate here, and operating immediately at 37 weeks adds iatrogenic prematurity without benefit. Note that Indian teaching follows this 20 mm cutoff consistent with international guidance.

Reference: Fernando Arias Practical Guide to High-Risk Pregnancy and Delivery, 5th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.