A woman at 38 weeks has painless bright red vaginal bleeding. The uterus is soft and non-tender and the fetal head is high. Which investigation must be avoided until placenta praevia is excluded?
Answer and explanation
Correct answer: B. Digital vaginal examination
- Step 1: Painless bleeding with a soft uterus and high head suggests placenta praevia.
- Step 2: A digital vaginal examination can provoke torrential haemorrhage, so ultrasound localises the placenta first.
Answer
Digital vaginal examination.
Why not the others: Transabdominal ultrasound scan of the placental site: Ultrasound is the diagnostic test. Fetal heart rate monitoring with a cardiotocograph: CTG is safe and needed to assess the baby. Abdominal examination of the uterus by palpation: Gentle abdominal palpation is safe.
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