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Question 64
Delivery suite → Haemorrhage
Classification
Question
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A 32-year-old woman at 34 weeks presents with painless vaginal bleeding. She is haemodynamically stable and the fetal heart rate is normal. The placental location has not previously been documented. Which examination should be avoided until placenta praevia has been excluded?
Question Stem
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Options
A
Abdominal palpation
B
Maternal blood pressure measurement
C
Speculum examination
D
Digital vaginal examination
E
Assessment of uterine tone
Explanation
When placenta praevia is possible, digital vaginal examination should not be performed until ultrasound has excluded it because digital examination can precipitate severe haemorrhage from a placenta covering or close to the cervical os. A speculum examination can be useful for identifying lower genital tract causes of bleeding and assessing cervical dilatation when clinically appropriate. Abdominal examination remains important for assessing tenderness, uterine tone and fetal presentation.
Option Validity
A) . abdominal examination forms part of APH assessment.
B) . maternal haemodynamic assessment is essential.
C) . speculum examination may be useful and is distinct from digital examination.
E) . assessment of uterine tone may provide important evidence of placental abruption.
Further Reading
RCOG Green-top Guideline No. 63. Antepartum Haemorrhage. 2011.