Vaginal bleeding after 28th weeks of pregnancy which is sudden onset, painless, causeless & recurrent is know… - RUHS, Jaipur, M.Sc Nursing Entrance Exam-2018

RUHS, Jaipur, M.Sc Nursing Entrance Exam-2018

Obstetrics & Gynaecology

Easy

Appeared in: RUHS, Jaipur, M.Sc Nursing Entrance Exam-2018

Explanation

Placenta previa is the implantation of the placenta in the lower uterine segment, either partially or completely covering the internal cervical os.
The hallmark symptom is painless, bright red vaginal bleeding that occurs after 28 weeks of gestation.
The bleeding is described as sudden, causeless, and recurrent because it results from the stretching and thinning of the lower uterine segment, which shears the inelastic placenta from its attachment without causing uterine contractions or pain.
The uterus typically remains soft, relaxed, and non-tender on palpation.

Option A: Abortion is the termination of pregnancy before the period of viability, which is typically defined as before 20 to 24 weeks of gestation. The question specifies bleeding after the 28th week.
Option B: Abruptio placenta is characterized by painful vaginal bleeding, often with a dark red color. The uterus is typically firm, rigid, and tender to palpation. The question specifies painless bleeding.
Option D: In vasa previa, fetal vessels traverse the membranes over the cervical os. Bleeding is painless but is typically initiated by rupture of the membranes and is fetal in origin, leading to acute and severe fetal distress. The recurrent and causeless nature described in the stem is more typical of placenta previa.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Clinical presentation of antepartum hemorrhage as background academic context rather than a clinical decision trigger.
A critical nursing responsibility for a patient with suspected placenta previa is to strictly avoid any vaginal examinations, as this can provoke catastrophic hemorrhage.
Immediate assessment includes monitoring maternal vital signs and fetal heart rate, establishing large-bore IV access, and preparing for potential emergency cesarean delivery.
Patient education should focus on the importance of pelvic rest (no intercourse, no douching) and seeking immediate care for any bleeding.

How to Approach the Question

First, identify the key clinical features presented in the question stem: gestational age (after 28 weeks), and the characteristics of the bleeding (sudden, painless, causeless, recurrent).
Evaluate each option against these key features.
Eliminate 'Abortion' because the gestational age is beyond the period of viability.
Differentiate between 'Placenta previa' and 'Abruptio placenta'. The defining feature here is pain. The question states the bleeding is 'painless', which points away from abruptio placenta (typically painful) and towards placenta previa.
Consider 'Vasa previa'. While painless, the bleeding in vasa previa is characteristically linked to membrane rupture and causes immediate fetal distress, which is not the primary description here. The recurrent and 'causeless' nature fits better with placenta previa.
Conclude that the classic tetrad of sudden, painless, causeless, and recurrent bleeding in the third trimester is the hallmark of placenta previa.

Concept Tested & Keywords

Concept Tested: Clinical presentation of antepartum hemorrhage
Stem keywords: Vaginal bleeding, 28th weeks of pregnancy, sudden onset, painless, causeless, recurrent
Lead-in keywords: is known as
Clinical cues: The combination of painless, causeless, and recurrent bleeding after 28 weeks is the classic sign of placenta previa.

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E6 Midwifery Obstetrics and Gynecology Nursing Sandeep Kaur p. 19-27

E6 Obstetrics Williams p. 71-94