A 32-year-old multipara at 30 weeks gestation presents with painless, bright red vaginal bleeding. Transabdominal ultrasound confirms that the placenta completely covers the internal cervical os. Which examination is strictly contraindicated?

Answer and explanation

Correct answer: A. Digital vaginal examination

  1. Step 1: Digital vaginal examination (or speculum examination without ultrasound confirmation) is strictly contraindicated in suspected or confirmed placenta previa.
  2. Step 2: Digital palpation of the internal os can disrupt the placental attachment and cause catastrophic, life-threatening maternal hemorrhage.
  3. Step 3: Placental location must be evaluated by ultrasound.
Answer
Digital vaginal examination.
Why not the others: 'External cardiotocography' is non-invasive and safe to monitor fetal wellbeing; 'Transvaginal ultrasound' performed carefully by an experienced sonographer is safe and superior to transabdominal imaging for locating the placental edge; 'Non-stress test' monitors fetal heart rate safely.

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