P/V examation is contraindcated in
High-Yield Explanation
(Placenta previa) (244- Dutta 7th)PLACENTA PREVIAVaginal examination must not be done outside the operation theater in the hospital, as it can provide further separation of placenta with torrential hemorrhage and may be fatal. It should only be done prior to termination of pregnancy in the operation theater under anesthesia, keeping everthing ready for casarean section* The regimen used for expectant management of placenta previa is- Macafee & Johnson regimen**Expectant Management of placenta previa* Rest (Absolute bed rest for up to 72 hours after bleeding stops)* Careful monitoring (clinical/ Laboratory/ USG every 2-3 weeks* Blood transfusion and Hematinics (maintain Hb atleast 10 g/dl and Hematocrit of 30%)* Antenatal steroids for foetal maturity (Between 24-34 weeks of gestation)* Anti D immunoglobulin (to all RH negative women)Use of Tocolysis (controversial) May be justified in selected cases but their use is not supported by strong evidenceCervical Encirclage - Not currently recommended insufficient evidence* First sign of magnesium toxicity is loss of deep tendon reflex* Bile acids represent best markers for intrahepatic cholestasis of pregnancy* Ursodiol (uricodeoxycholic acid) is treatment of choice for Intrahepatic cholestases in pregnancy* Methotrexate is absolutely contraindicated during pregnancy (class x)and lactation due to its potential for spontaneous abortion and teratogenecity* Transplacental transmission is rare with both Herpes simplex and Hepatitis B