A 31-year-old multipara at 32 weeks of gestation presents to the labor ward with sudden-onset, painless bright red vaginal bleeding. She denies abdominal pain or uterine contractions. Maternal vital signs are stable, and fetal heart rate is reassuring at 140 bpm. What initial clinical examination is strictly contraindicated prior to obtaining an obstetrical ultrasound?

Answer and explanation

Correct answer: B. Digital vaginal cervical examination

  1. Step 1: Painless vaginal bleeding in the third trimester is the hallmark presentation of Placenta Previa (placental tissue overlying or abutting the internal cervical os).
  2. Step 2: Digital vaginal examination (digital exam of the cervix) is strictly contraindicated because inserting a examining finger into the cervix can tear the placenta, provoking catastrophic, life-threatening maternal-fetal hemorrhage.
  3. Step 3: Diagnosis must be established safely using transabdominal or gentle transvaginal ultrasonography.
Answer
Digital vaginal cervical examination.
Why not the others: 'Cardiotocography' is safe and essential to evaluate fetal status; 'Sterile speculum exam' may be performed very cautiously after ultrasound confirms placental position; 'Abdominal palpation' is safe and typically reveals a soft, non-tender uterus in placenta previa.

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