The expectant line of management in placenta prae is contraindicated in
**Core Concept**
Expectant management in placenta previa involves closely monitoring the patient's condition without intervening, often with serial ultrasounds and bed rest, in the hope that the placenta will migrate away from the cervix. This approach is generally recommended for women with stable, low-lying placentas.
**Why the Correct Answer is Right**
The expectant line of management in placenta previa is contraindicated in cases where there is significant vaginal bleeding, fetal distress, or a non-viable fetus. In such situations, immediate delivery is necessary to ensure the well-being of both the mother and the fetus. This is because the risk of maternal and fetal morbidity and mortality increases with each episode of vaginal bleeding, and expectant management may only delay the inevitable need for delivery.
**Why Each Wrong Option is Incorrect**
**Option A:** This option is incorrect because it does not provide a clear contraindication for expectant management. While certain conditions may necessitate delivery, they do not necessarily preclude expectant management as the initial approach.
**Option B:** This option is incorrect because it is not a direct contraindication for expectant management. In fact, women with a history of previous cesarean delivery or uterine surgery may be at increased risk for placenta previa, but expectant management may still be considered if the placenta is not significantly low-lying.
**Option C:** This option is incorrect because it is not a direct contraindication for expectant management. Women with multiple gestations may be at increased risk for placenta previa, but expectant management may still be considered if the placenta is not significantly low-lying.
**Option D:** This option is incorrect because it is not a direct contraindication for expectant management. Women with a history of previous placenta previa may be at increased risk for recurrence, but expectant management may still be considered if the placenta is not significantly low-lying.
**Clinical Pearl / High-Yield Fact**
In cases of suspected placenta previa, a thorough ultrasound examination should be performed to confirm the diagnosis and determine the location of the placenta. A placenta previa is typically characterized by the presence of a "placental edge" near or over the internal cervical os.
**Correct Answer: D.**