In case of suspected placenta previa the vaginal examination is advisable

RRB Nsg. Superintendent -29 April-2025 (shift-2nd)

Obstetrics & Gynaecology

Easy

Appeared in: RRB Nsg. Superintendent -29 April-2025 (shift-2nd)

Explanation

In suspected placenta previa, a digital vaginal examination is absolutely contraindicated until the placental location is confirmed to be away from the cervical os.
The primary diagnostic tool is ultrasound (transabdominal followed by transvaginal if needed) to safely visualize the placenta.
Performing a vaginal exam can disrupt the low-lying placenta, triggering massive, life-threatening hemorrhage.
A vaginal exam is only considered safe after placenta previa has been definitively ruled out by ultrasound.

Option A: While a vaginal exam can assess fetal position, it is extremely dangerous in suspected placenta previa. Ultrasound is the safe and accurate method for this assessment.
Option B: Placental abnormalities are diagnosed via imaging, primarily ultrasound, not by a physical vaginal examination.
Option C: Congenital abnormalities of the fetus are identified through prenatal screening, detailed ultrasound, or genetic testing, not by a digital vaginal exam.

Visual 1: Diagram - Illustration showing a complete placenta previa with the placenta covering the internal cervical os. A second panel should show a hand attempting a vaginal exam, with an arrow indicating the risk of hemorrhage.
Visual 2: Ultrasound Image - A transvaginal ultrasound image clearly demonstrating a placenta previa, with the placental edge overlying the cervix.
Visual 3: Flowchart - A decision-making flowchart for a patient with third-trimester bleeding, starting with 'No Vaginal Exam', leading to 'Ultrasound', and then branching to different management paths based on the finding of previa or no previa.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Management of suspected placenta previa and contraindications for vaginal examination as background academic context rather than a clinical decision trigger.
The absolute contraindication of vaginal exams in suspected placenta previa is a cornerstone of safe obstetric practice. A nurse's primary role is patient advocacy and safety; therefore, they must be empowered to question and prevent this potentially catastrophic procedure.
Nurses should ensure that any patient presenting with painless vaginal bleeding after 20 weeks of gestation has a sign at the bedside clearly stating 'NO VAGINAL EXAMS'.
What if? If a patient with suspected placenta previa is in active labor with a non-reassuring fetal heart rate, a vaginal exam is still contraindicated. The management would be immediate preparation for an emergency cesarean delivery, as this is the safest route for both mother and baby.

How to Approach the Question

Identify the keywords in the question: 'suspected placenta previa' and 'vaginal examination'.
Recognize that this is a critical safety question. The term 'placenta previa' should immediately trigger a mental alert about the risk of hemorrhage.
Recall the absolute contraindication: Digital vaginal exams are forbidden in suspected placenta previa until its location is confirmed by ultrasound.
Evaluate each option based on this core safety principle.
Option A, B, and C suggest performing the exam for diagnostic purposes that are better and more safely served by ultrasound.
Option D presents the only condition under which a vaginal exam would be safe: after the primary risk (previa) has been ruled out using the appropriate diagnostic tool (ultrasound).

Concept Tested & Keywords

Concept Tested: Management of suspected placenta previa and contraindications for vaginal examination.
Stem keywords: placenta previa, vaginal examination
Lead-in keywords: advisable
Clinical cues: suspected placenta previa

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