A patient with placenta previa requires vaginal examination. What should the nurse do and why?

A patient with placenta previa requires vaginal examination. What should the nurse do and why?

• A. Do not perform vaginal examination; placenta previa is a contraindication to vaginal exams due to risk of hemorrhage.
• B. Proceed with vaginal examination to assess placenta placement.
• C. Obtain an abdominal ultrasound to locate placenta before any vaginal exam.
• D. Initiate cesarean delivery without assessment.

Answer: (A)

Placenta previa is a condition where the placenta implants low in the uterus, near or over the cervical os. Manipulating the cervix with a vaginal examination can disrupt the placental attachment and cause rapid, heavy bleeding that can be life-threatening for both mother and fetus. Because of this risk, a vaginal exam is contraindicated. The safe approach to assess placental location is to use noninvasive imaging, typically an abdominal ultrasound, to identify where the placenta is before any vaginal contact. If placenta previa is confirmed (and especially if there is bleeding), plan for delivery by cesarean section as indicated. In the interim, manage per obstetric protocol and avoid vaginal procedures until placental location has been clarified.

Placenta previa is a condition where the placenta implants low in the uterus, near or over the cervical os. Manipulating the cervix with a vaginal examination can disrupt the placental attachment and cause rapid, heavy bleeding that can be life-threatening for both mother and fetus. Because of this risk, a vaginal exam is contraindicated.

The safe approach to assess placental location is to use noninvasive imaging, typically an abdominal ultrasound, to identify where the placenta is before any vaginal contact. If placenta previa is confirmed (and especially if there is bleeding), plan for delivery by cesarean section as indicated. In the interim, manage per obstetric protocol and avoid vaginal procedures until placental location has been clarified.