Third-trimester vaginal bleeding with placenta previa; which prescription should be questioned?

• 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 implants near or over the cervical opening, so inserting fingers into the vagina (a manual pelvic exam) can disrupt the placental attachment and cause massive, life-threatening bleeding. Because of this risk, performing a manual pelvic examination should be avoided and is something to question.

The appropriate approach is to confirm placental location with imaging—usually an ultrasound—before any vaginal examination. Meanwhile, monitor the fetus with external electronic fetal heart rate monitoring and assess maternal status (for example, by checking hemoglobin/hematocrit) to evaluate blood loss and the need for interventions.