A pregnant woman with placenta previa presents with mild bleeding. There are no uterine contractions, her blood pressure is 110/70 mm Hg, and the fetal heart rate is 140 bpm. What is the best next step in management?

1. A

   Hospitalization and expectant management

2. B

   Oxytocin induction of labor

3. C

   Immediate lower segment cesarean section (LSCS)

4. D

   ARM

Appeared in: INI-CET EXAM -2025

Explanation

• The patient's clinical presentation is stable, with only mild bleeding and no signs of maternal or fetal compromise.
• In such cases, especially if the pregnancy is preterm, the standard of care is expectant management to allow the fetus to mature further.
• This involves admitting the patient to the hospital for close monitoring of maternal vital signs, amount of bleeding, and fetal well-being.
• Active interventions are reserved for situations where bleeding becomes severe, or if maternal or fetal stability is compromised.

Why Other Options Were Wrong

• Option B: Inducing labor with oxytocin is strictly contraindicated in placenta previa. The resulting uterine contractions can cause the dilating cervix to tear the overlying placenta, leading to life-threatening hemorrhage.
• Option C: An immediate C-section is not warranted because both the mother and fetus are stable. This is an emergency procedure reserved for severe, active bleeding, fetal distress, or when the pregnancy reaches term.
• Option D: Artificial rupture of membranes (ARM) is absolutely contraindicated. The placenta is located over or near the cervix, and attempting to rupture the membranes could directly puncture the placenta, causing immediate and massive hemorrhage.

Related Visual

• Visual 1: Diagram - An illustration showing the different types of placenta previa (complete, partial, marginal, and low-lying) to help visualize how the placenta's position over the cervical os leads to bleeding.
• Visual 2: Flowchart - A decision-making algorithm for managing antepartum hemorrhage, showing the pathway for stable patients with placenta previa (expectant management) versus unstable patients (emergency C-section).

Clinical Relevance

• Nursing practice connection: Use the key finding related to Management of Placenta Previa to guide bedside assessment, documentation, and the next nursing action.
• The cornerstone of managing stable placenta previa is 'watchful waiting' or expectant management in a hospital setting to maximize fetal maturity while being prepared for an emergency.
• Nursing care involves strict monitoring of vaginal bleeding (pad counts), maternal vital signs, and continuous or intermittent fetal heart rate monitoring. Any increase in bleeding or change in vitals must be reported immediately.
• A critical safety measure is to ensure 'pelvic rest,' meaning absolutely no vaginal examinations, as this can provoke catastrophic hemorrhage.

How to Approach the Question

• First, identify the core clinical problem: a pregnant woman with known placenta previa and vaginal bleeding.
• Next, assess the stability of the mother and fetus. Read the vital signs carefully: BP is 110/70 (stable), bleeding is 'mild', and FHR is 140 bpm (normal and reassuring).
• Recognize that in a stable scenario with a preterm fetus, the goal is to prolong the pregnancy safely. This is called expectant management.
• Evaluate the options based on this goal. 'Hospitalization and expectant management' directly aligns with this strategy.
• Critically evaluate the other options for contraindications. Recognize that oxytocin induction and ARM are extremely dangerous in placenta previa and can cause severe hemorrhage.
• Understand that immediate C-section is an emergency intervention for unstable patients, which this patient is not. Therefore, it is not the 'best next step'.

Concept Tested & Keywords

• Concept Tested: Management of Placenta Previa
• Stem keywords: placenta previa, mild bleeding, no uterine contractions, stable blood pressure, normal fetal heart rate
• Lead-in keywords: best next step
• Clinical cues: The combination of mild bleeding, stable maternal vitals (BP 110/70), and a normal fetal heart rate (140 bpm) points towards a non-emergent situation, allowing for conservative management.

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