A 21-year-old primigravida is admitted at 39 weeks gestation with painless antepartum hemorrhage. On examination uterus is soft non-tender and head engaged. The management for her would be:
Correct Answer: Pelvic examination in OT
Description: Ans. is c, i.e. Pelvic examination in OTRef. Dutta Obs. 7/e. p 249Patient is presenting with painless vaginal bleeding and uterus is soft and nontender. These findings point towards the diagnosis of placenta previa (In abruptio-bleeding is accompanied by pain, uterus is tense, tender and rigid).The gestational age of patient is 39 weeks i.e., fetal maturity is attained so pregnancy has to be terminated, either vaginally or by cesarean section.Now to decide the mode of delivery, we need to know which of placenta previa it is. This can be known by USG or pelvic examination in OT. Since USG is not given in options so answer is pelvic examination in OT.Also Know:Conditions where vaginal examination should not be done (even in OT):1. Patient is in exsanguinated state Q2. Diagnosed case of placenta previa on USG Q3. Associated complicating factors such as malpresentation, elderly primigravida, previous cesarean section, contracted pelvis etc Q which prevent vaginal delivery.As in all these conditions cesarean section is mandatory (so no point in wasting time to know the type of placenta previa by vaginal examination and taking the risk of occurrence of brisk hemorrhage).
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Gynaecology & Obstetrics
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