A 32-week pregnant woman is admitted to the hospital with a diagnosis of placenta previa after an episode of painless, bright red vaginal bleeding. The bleeding has currently subsided. Which of the following interventions is the most appropriate initial nursing action?

Appeared in: HPSSC - 2015

Explanation

Placenta previa is characterized by the implantation of the placenta over or near the internal cervical os, making it prone to separation and bleeding.
The primary risk is sudden, unpredictable, and massive hemorrhage, which can be life-threatening for both the mother and fetus.
Securing large-bore IV access is the highest priority initial intervention for a stable patient. It is a crucial preparatory step that allows for immediate resuscitation with fluids or blood products if hemorrhage occurs.
Drawing blood for type and cross-match is done concurrently to ensure that compatible blood is readily available.

Option A: Performing any type of vaginal examination (digital or speculum) is absolutely contraindicated in a woman with known or suspected placenta previa.
Option C: An immediate emergency cesarean section is not indicated because the patient's bleeding has subsided, and she is currently stable. The fetus is also preterm at 32 weeks.
Option D: Encouraging ambulation is contraindicated. It increases intra-abdominal pressure and the risk of provoking another bleeding episode.

Clinical Relevance

Nursing practice connection: Safe nursing care depends on performing Initial nursing management of placenta previa in the correct sequence, documenting the action clearly, and monitoring for the expected response.
Anticipating and preparing for hemorrhage is a core nursing responsibility in managing placenta previa. Always assume the worst-case scenario is possible.
The principle of 'no vaginal exams' in women with third-trimester bleeding until placenta previa is ruled out by ultrasound is a critical patient safety rule.
Nurses must be prepared for a 'double setup' examination, where the patient is taken to the operating room for a vaginal exam, with the surgical team ready to perform an immediate cesarean section if bleeding is initiated.

How to Approach the Question

First, identify the patient's diagnosis: a 32-week pregnant woman with placenta previa.
Recognize the key clinical feature: painless, bright red vaginal bleeding, which is the classic sign of placenta previa.
Note the patient's current status: the bleeding has subsided, meaning she is currently stable but remains at high risk.
Analyze the core risk of placenta previa: sudden, massive hemorrhage.
Evaluate the options based on safety and priority. The primary goal is to be prepared for the most severe potential complication.
Eliminate options that are dangerous or contraindicated: Vaginal exams (Option A) and ambulation (Option D) are strictly forbidden as they can provoke bleeding.

Concept Tested & Keywords

Concept Tested: Initial nursing management of placenta previa
Stem keywords: 32-week pregnant, placenta previa, painless, bright red vaginal bleeding, bleeding has currently subsided, initial nursing action
Lead-in keywords: most appropriate, initial
Clinical cues: Diagnosis of placenta previa: This is a high-risk condition known for potential massive hemorrhage.
Clinical cues: Bleeding has subsided: This indicates the patient is currently stable, allowing for preparatory measures rather than immediate emergency action.

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E6 Obstetrics Williams p. 68-93

E6 Midwifery Obstetrics and Gynecology Nursing Sandeep Kaur p. 23-31

Practise the full HPSSC - 2015

Attempt every question from this paper in a timed mock, then review the full solution for each one.