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Placenta previa — MCCQE Part 1 MCQ

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ModerateVaginal BleedingPlacenta previaMCCQE Part 1

36-year-old woman at 31 weeks' gestation presents with painless bright red vaginal bleeding. Fetal heart rate is reassuring and placenta location is unknown. Which of the following is the most appropriate next step?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: A — Avoid digital vaginal examination and obtain ultrasound with obstetric consultation

Avoid digital vaginal examination and obtain ultrasound with obstetric consultation is best because painless third-trimester bleeding requires exclusion of placenta previa before digital exam. Discharge without pregnancy-specific safety-netting is suboptimal because pregnancy-related bleeding, pain or hypertension can deteriorate quickly; Perform a digital vaginal examination before excluding placenta previa or instability is suboptimal because digital examination can precipitate haemorrhage when placenta previa is possible; Use a medication contraindicated in pregnancy as first-line therapy is suboptimal because maternal treatment must account for fetal safety and gestational age; Delay obstetric or gynaecologic consultation despite red flags is suboptimal because specialist involvement is needed when maternal or fetal risk is present. A speculum exam may be considered in selected settings, but digital exam is avoided until previa excluded.

Reference: SOGC antepartum haemorrhage guidance