A 31-year-old G2P1 at 38 weeks has an anterior placenta with its lower edge located 25 mm from the internal os on transvaginal ultrasound. She has had one previous vaginal delivery and no episodes of bleeding. The most appropriate plan for delivery is:
- A Elective cesarean section at 38 weeks
- B Elective cesarean section at 34 weeks
- C Trial of labor with arrangements for emergency cesarean if bleeding occurs ✓
- D Induction of labor only after double set-up examination in theater
Correct answer: C. Trial of labor with arrangements for emergency cesarean if bleeding occurs
Explanation
When the placental edge lies more than 20 mm from the internal os on transvaginal scan at term, a planned vaginal delivery is considered safe, since the distance correlates with the likelihood of hemorrhage during labor. Cesarean is reserved for distances of 20 mm or less. The double set-up examination is obsolete because transvaginal sonography provides the measurement safely, and 34 weeks is far too early for an asymptomatic patient.
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.