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Placenta previa


Step 1: View clinicals

A 30 year old woman presents with spontaneous painless vaginal bleeding at 32 weeks of her third pregnancy. She experienced vaginal spotting about a month ago, after she had engaged in sexual intercourse. Her medical history is unremarkable, while her two previous pregnancies were uncomplicated, ending with vaginal deliveries at term.

Step 2: Order all relevant investigations

Transvaginal Ultrasound

The ultrasound scan shows an anterior placenta in the lower uterine segment, with its inferior edge partially overlapping the internal cervical os.


Cardiotocography shows a baseline fetal heart rate of 150 bpm with normal variability and periodic accelerations. There are no decelerations; nor is there evidence of uterine contractions.

Grouping & Crossmatching

Her blood group is O negative. Two pints of blood are crossmatched and reserved.

MRI Abdomen

You realize that the resultant delay might not be a good idea in a patient with recent bleeding.

Step 3: Select appropriate management

Transfuse Blood
Urgent Cesarean Section
Anti-D Immunoglobulin
IM Corticosteroids

Score: ★★☆