Obstetrics & Gynecology>>>>>Maternal-Fetal Physiology and Placentation
Question 8#

You are the third year medical student assigned to labor and delivery. A 29-year-old P3003 at 29 weeks with known placenta previa presents to the triage area with a report of vaginal bleeding. The fetal heart tracing is reactive and the bleeding is minimal. You take history and present her to your intern. You accompany the intern to triage to further evaluate the patient together. Your intern confirms the history and prepares to perform a digital cervical examination.

What should your next step be in this situation?

A. Watch the intern perform a digital cervical examination
B. Ask if you may also perform a digital cervical examination
C. Remind the intern that the patient has a placenta previa and should not have a digital cervical examination
D. Suggest that the intern perform an ultrasound to evaluate the placenta
E. Do not say anything at the time, but afterward remind the intern that the patient has a placenta previa and should not have a digital cervical examination

Correct Answer is C

Comment:

Patient safety has no hierarchy. Placenta previa is a condition where the placenta is implanted over the internal cervical os. Digital cervical examination is contraindicated in this setting due to the possibility of causing severe hemorrhage. The correct next step is to speak up to make sure the intern knows that the patient has a placenta previa and should not have a digital cervical examination.