A 28-week pregnant woman presents with painless, bright red vaginal bleeding. Ultrasound confirms placenta previa. Which intervention should the nurse strictly avoid, and what is the primary initial management plan?

Appeared in: PGIMER Nursing Officer - 2025

Explanation

Digital vaginal examination is strictly contraindicated in placenta previa due to risk of massive hemorrhage.
Initial management focuses on maternal stabilization, IV access, monitoring, and preparation for cesarean section.
Ultrasound is the preferred diagnostic tool for placental localization.
The key differentiator is that digital vaginal examination can directly cause catastrophic bleeding in placenta previa.

Option A: This option correctly lists the interventions to avoid and the initial management plan, but it is not the one that describes the action to strictly avoid. The question specifically asks which intervention should be strictly avoided, making the digital vaginal examination the focus.
Option C: Starting oxytocin infusion for rapid delivery is contraindicated in placenta previa because vaginal delivery is not recommended due to the risk of hemorrhage. Oxytocin is used for induction or augmentation of labor in other scenarios, not when placenta previa is present.
Option D: Placing the patient in high Fowler's position and performing a pelvic assessment is not appropriate in placenta previa. High Fowler's position is not standard for bleeding management, and pelvic assessment (especially digital) is contraindicated.

Clinical Relevance

Nursing practice connection: Use the key finding related to Contraindicated interventions and initial management in placenta previa to guide bedside assessment, documentation, and the next nursing action.
Nurses must recognize that digital vaginal examination is absolutely contraindicated in placenta previa to prevent maternal and fetal morbidity or mortality.
Immediate stabilization and preparation for possible cesarean section are critical nursing actions.
What if? If the nurse performs a digital vaginal exam in a woman with undiagnosed placenta previa, it can trigger uncontrollable hemorrhage, requiring emergency cesarean and risking maternal and fetal life.

How to Approach the Question

Identify the clinical scenario: painless, bright red bleeding in late pregnancy suggests placenta previa.
Recall that digital vaginal examination is contraindicated in placenta previa due to hemorrhage risk.
Eliminate options that involve any form of vaginal or pelvic examination.
Choose the option that describes the action to strictly avoid, not just the general management plan.
For scenario-based questions, always prioritize patient safety and actions that prevent harm.

Concept Tested & Keywords

Concept Tested: Contraindicated interventions and initial management in placenta previa
Stem keywords: 28-week pregnant woman, painless bright red vaginal bleeding, ultrasound, placenta previa
Lead-in keywords: strictly avoid, primary initial management plan
Clinical cues: Painless, bright red bleeding is classic for placenta previa
Clinical cues: Ultrasound confirmation rules out abruption

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E6 Obstetrics Williams pp. 68-93, 72-95

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