A G5P4 at 31 weeks with known complete placenta previa presents with a second bout of brisk bright red vaginal bleeding, now estimated at 1200 mL. Pulse 128/min, BP 82/50 mmHg, and the fetal heart tracing shows recurrent late decelerations. Resuscitation with crystalloids is underway. The next definitive step in management is:

• A Continue expectant management with serial hemoglobin estimation
• B Emergency cesarean delivery irrespective of gestational age ✓
• C Administer betamethasone and defer delivery for 48 hours
• D Attempt vacuum-assisted vaginal delivery in the operating room

Explanation

When hemorrhage from placenta previa threatens the life of the mother or produces evidence of fetal compromise such as late decelerations, delivery is indicated immediately regardless of gestational age, by cesarean section. Expectant management and steroid timing apply only to the stable mother with a preterm viable fetus. Vaginal delivery is absolutely contraindicated with a complete previa covering the os, since separation of the placenta during cervical dilation causes catastrophic hemorrhage.

Reference: Williams Obstetrics, 26th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.