Placenta Previa: The Daily PANCE Blueprint
A 28-year-old woman, 30 weeks pregnant, presents with sudden onset of painless, bright red vaginal bleeding. There is no history of trauma, and her pregnancy has been uneventful. Her vital signs are stable. What is the most appropriate next step in the diagnosis of this patient's condition?
A. Digital vaginal examination
B. Transabdominal ultrasound
C. Transvaginal ultrasound
D. Magnetic resonance imaging (MRI) of the pelvis
E. Immediate cesarean delivery
Answer and topic summary
The answer is C. Transvaginal ultrasound
Transvaginal ultrasound is the most appropriate next step in diagnosing placenta previa. It provides a clear image of the lower uterine segment and placental location without the risks associated with a digital vaginal examination, which could potentially disrupt the placenta and worsen bleeding.
Incorrect Answers:
A. Digital vaginal examination – This is contraindicated in cases of suspected placenta previa due to the risk of provoking severe hemorrhage by disrupting the placenta.
B. Transabdominal ultrasound – While this can be used to assess placental location, transvaginal ultrasound is generally more accurate for diagnosing placenta previa, especially when the placenta is located in the lower uterine segment.
D. Magnetic resonance imaging (MRI) of the pelvis – MRI is not typically used as a first-line diagnostic tool for placenta previa. It may be used in complex cases where ultrasound results are inconclusive.
E. Immediate cesarean delivery – While cesarean delivery might be necessary for placenta previa, it is not the immediate next step for diagnosis. The condition must be confirmed first, typically via ultrasound.
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Smarty PANCE Content Blueprint Review:
Covered under ⇒ PANCE Blueprint Reproductive System ⇒ ⇒
Also covered as part of the Women's Health EOR and Emergency Medicine EOR topic lists
