Which of the following is the management of partial placenta previa?

HP CHO -9 October 2022

Obstetrics & Gynaecology

Easy

Appeared in: HP CHO -9 October 2022

Explanation

Partial placenta previa is a condition where the placenta is implanted over a portion of the internal cervical os.
During labor, as the cervix dilates, the placenta separates from the uterine wall, leading to inevitable and potentially life-threatening hemorrhage.
A Caesarean section is the definitive and safest mode of delivery because it allows the fetus to be delivered without disturbing the placenta, thus preventing massive bleeding.
This approach prioritizes both maternal and fetal safety by avoiding the risks associated with vaginal delivery in this context.

Option B: Blood transfusion is a supportive therapy to treat a complication (hemorrhage), not the primary management to resolve the underlying condition. It replaces lost blood but does not prevent the bleeding from occurring.
Option C: Dilation and Curettage (D&C) is absolutely contraindicated. The procedure involves instrumenting the cervix and uterus, which would directly disrupt the low-lying placenta and cause immediate, torrential hemorrhage.
Option D: While complete bed rest is a crucial part of managing placenta previa, it is a component of expectant (conservative) management, not the definitive treatment for delivery. Its goal is to prolong a preterm pregnancy.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Management of Placenta Previa as background academic context rather than a clinical decision trigger.
The absolute cardinal rule in nursing practice for a patient with suspected or confirmed placenta previa is: NO digital vaginal examinations. This can provoke life-threatening hemorrhage.
Nurses must be prepared for a potential obstetric emergency. This includes ensuring large-bore IV access, having blood products readily available (type and crossmatch), and continuous fetal and maternal monitoring.
Patient education is vital. The patient and her family must understand the signs of increased bleeding and the need for immediate transport to the hospital.

How to Approach the Question

First, identify the clinical condition presented in the question: 'partial placenta previa'.
Recall the core pathophysiology and primary risk of this condition, which is severe, painless hemorrhage resulting from placental separation as the cervix dilates.
Analyze each option in the context of this primary risk.
Evaluate 'Caesarean section'. This surgical delivery bypasses the cervix, directly avoiding the risk of hemorrhage from cervical dilation. This is a definitive solution for delivery.
Evaluate 'Blood transfusion'. This treats a potential complication (hemorrhage) but does not prevent it. It's a reactive, supportive measure.
Evaluate 'Dilation and Curettage (D&C)'. This procedure would actively cause the primary complication by instrumenting the cervix and uterus. It is contraindicated.

Concept Tested & Keywords

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E6 Obstetrics Williams p. 72-95