A 21 year old primigravida is admitted at 39 weeks gestation with painless antepaum hemorrhage. On examination uterus is soft non-tender and head engaged. The management for her would be :

Ans. is c i.e. Pelvic examination in OT Patient is presenting with painless vaginal bleeding and uterus is soft and nontender. These findings confirm the diagnosis of placenta pre (In abruptio-bleeding is accompanied by pain, uterus is tense, tender and rigid). The gestational age of patient is 39 weeks i.e., fetal maturity is attained and pregnancy has to be terminated either vaginally or by cesarean section. Before termination of pregnancy, vaginal examination should be done in OT (keeping everything ready for cesarean section) to know : -- The degree of placenta pre To assess whether vaginal delivery is possible or not. Remember Vaginal examination should not be done outside the operation theatre as it can provoke fuher separation of placenta with torrential bleeding which may be fatal. These days the need for carrying out vaginal examination in OT has decreased as the patients have an antenatal ultrasound specifying the degree of placenta pre. Also Knov. Conditions where vaginal examination should not be done (even in OT) Patient is in exsanguinated statedeg. Diagnosed cases of major placenta pre on USGdeg Associated complicating factors such as malpresentation, elderly primigravida, previous cesarean section. Luriiith,led pelvis etcdeg which prevent vdginal delivery. As in all these conditions cesarean section is mandatory (so no point in wasting time to know the type of placenta pre by vaginal examination and taking the risk of occurrence of brisk hemorrhage).