A female at 37 week of pregnancy comes with grade 3 placenta pre, bleeding per vaginum with uterine contractions. What is the MOST appropriate management in this patient?
**Core Concept:** Placenta previa is a condition in which the placenta is implanted low in the uterus and covers at least part of the cervix. Grade 3 placenta previa refers to the placenta covering the entire internal os, increasing the risk of heavy bleeding during labor or delivery.
**Why the Correct Answer is Right:** The correct answer, option C, "Induction of labor," is chosen due to the patient's symptoms of grade 3 placenta previa, which includes heavy bleeding per vaginum and uterine contractions. Induction of labor allows for timely delivery of the fetus to prevent further complications and reduce the risk of maternal hemorrhage during delivery.
**Why Each Wrong Option is Incorrect:**
A. **Medical management (waiting and monitoring):**: This strategy does not address the immediate risk of heavy bleeding and uterine contractions in a patient with grade 3 placenta previa.
B. **Observation without intervention**: Observation without intervention is not an appropriate management for a patient presenting with symptoms of grade 3 placenta previa, as it exposes the patient to severe complications and does not address the bleeding and contractions.
D. **Cervical cerclage**: Cervical cerclage is an appropriate procedure for preventing preterm labor and improving pregnancy outcomes in cases of cervical insufficiency, not for placenta previa. In this scenario, induction of labor is the more suitable management option.
**Clinical Pearl:** In cases of grade 3 placenta previa, timely management with induction of labor is crucial to prevent severe complications and maternal hemorrhage during delivery. Adequate knowledge about different management options and understanding their indications and contraindications is essential to provide appropriate patient care.