NORCET 1 - 2020
Obstetrics & Gynaecology
Easy
In placenta previa and bleeding of gastation investigation of choice ?
Appeared in: NORCET 1 - 2020
Explanation
- Ultrasonography (USG) is the gold standard for diagnosing placenta previa because it is safe, accurate, and readily available.
- USG does not use ionizing radiation, posing no risk to the developing fetus.
- Transvaginal sonography (TVS) is the most precise method for visualizing the relationship between the placental edge and the internal cervical os and is considered safe even in the presence of bleeding.
Why Other Options Were Wrong
- Option B: A CT scan exposes the fetus to significant ionizing radiation, which is contraindicated in pregnancy for placental localization.
- Option C: MRI is not the initial investigation of choice due to its higher cost, limited availability, and longer examination time compared to ultrasound.
- Option D: A pelvic X-ray is an obsolete and inaccurate method for placental localization that exposes the fetus to unnecessary radiation.
Related Visual
- Visual 1: Diagram - An illustration showing the different classifications of placenta previa: complete, partial, marginal, and low-lying, in relation to the cervix.
- Visual 2: Image - A transvaginal ultrasound image clearly demonstrating a posterior placenta completely covering the internal cervical os, confirming a diagnosis of complete placenta previa.
Clinical Relevance
- Nursing practice connection: Knowing Diagnostic imaging for placenta previa helps nurses interpret findings accurately and avoid errors in routine assessment, medication administration, and patient teaching.
- A core nursing safety principle for any patient with antepartum hemorrhage is to never perform a digital vaginal examination until placenta previa has been definitively ruled out by ultrasound. This action can cause catastrophic bleeding.
- Nurses must be vigilant in monitoring for any vaginal bleeding, assessing its quantity, and observing for signs of maternal hemodynamic compromise (tachycardia, hypotension, pallor), as these may indicate the need for urgent intervention.
- Patient education is critical. The nurse should instruct the patient on the importance of 'pelvic rest' (no intercourse, no douching) and to report any bleeding or contractions to the hospital immediately.
How to Approach the Question
- First, identify the clinical scenario: a pregnant patient with bleeding, where placenta previa is a primary concern.
- Analyze the question's core requirement: 'investigation of choice'. This asks for the best first-line test, considering safety, accuracy, and standard clinical practice.
- Evaluate the options based on safety during pregnancy. Immediately recognize that methods involving ionizing radiation (CT scan, Pelvic X-ray) are generally avoided due to potential harm to the fetus.
- Compare the remaining non-radiation options: USG and MRI. While both are safe, consider which is the standard initial diagnostic tool.
- Recall that ultrasonography is the cornerstone of obstetric imaging due to its safety, cost-effectiveness, and high accuracy for this specific purpose.
- Conclude that USG is the most appropriate 'investigation of choice' over MRI, which is reserved for more complex secondary evaluation.
Concept Tested & Keywords
- Concept Tested: Diagnostic imaging for placenta previa
- Stem keywords: placenta previa, bleeding, gestation, investigation of choice
- Lead-in keywords: investigation of choice
- Clinical cues: Bleeding during gestation is a key indicator for investigating placental location.
Question ID
QmhujCX0oQMP-W6P2iIxQ-
Practise the full NORCET 1 - 2020
Attempt every question from this paper in a timed mock, then review the full solution for each one.
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