During management of a patient with placenta previa, which prescription should the nurse question?

During management of a patient with placenta previa, which prescription should the nurse question?

• A. Prepare the client for an ultrasound
• B. Obtain equipment for a manual pelvic examination
• C. Prepare to draw a hemoglobin and hematocrit
• D. Obtain equipment for external electronic fetal heart rate monitoring

Answer: (B)

In placenta previa, the placenta lies near or over the cervical os, which makes a vaginal (manual) pelvic examination dangerous. Inserting a finger into the vagina can disrupt the placental attachment and trigger heavy, potentially life-threatening bleeding. Because of this, a prescription to perform a manual pelvic examination should be questioned. Noninvasive assessments are preferred: ultrasound is the diagnostic test of choice to locate the placenta, external electronic fetal heart rate monitoring helps assess the fetus during bleeding episodes, and drawing hemoglobin/hematocrit evaluates blood loss and anemia. Internal vaginal exams are avoided until placenta previa is ruled out or delivery is imminent, to prevent triggering hemorrhage.

In placenta previa, the placenta lies near or over the cervical os, which makes a vaginal (manual) pelvic examination dangerous. Inserting a finger into the vagina can disrupt the placental attachment and trigger heavy, potentially life-threatening bleeding. Because of this, a prescription to perform a manual pelvic examination should be questioned.

Noninvasive assessments are preferred: ultrasound is the diagnostic test of choice to locate the placenta, external electronic fetal heart rate monitoring helps assess the fetus during bleeding episodes, and drawing hemoglobin/hematocrit evaluates blood loss and anemia. Internal vaginal exams are avoided until placenta previa is ruled out or delivery is imminent, to prevent triggering hemorrhage.