During management of a patient with placenta previa, which prescription should the nurse question?

• A. Prepare the client for an ultrasound
• B. Obtain equipment for a manual pelvic examination
• C. Prepare to draw a hemoglobin and hematocrit
• D. Obtain equipment for external electronic fetal heart rate monitoring

Answer: (B)

In placenta previa, the placenta lies near or over the cervical os, which makes a vaginal (manual) pelvic examination dangerous. Inserting a finger into the vagina can disrupt the placental attachment and trigger heavy, potentially life-threatening bleeding. Because of this, a prescription to perform a manual pelvic examination should be questioned.

Noninvasive assessments are preferred: ultrasound is the diagnostic test of choice to locate the placenta, external electronic fetal heart rate monitoring helps assess the fetus during bleeding episodes, and drawing hemoglobin/hematocrit evaluates blood loss and anemia. Internal vaginal exams are avoided until placenta previa is ruled out or delivery is imminent, to prevent triggering hemorrhage.