A 34-year-old woman at 32 weeks of pregnancy presents with painless vaginal bleeding. She is haemodynamically stable, and the fetal heart rate is normal. What is the most appropriate next step? A) Speculum examination B) Digital vaginal examination C) Immediate cesarean section D) Transabdominal ultrasound E) Administer anti-D immunoglobulin Correct Answer: D) Transabdominal ultrasound Explanation: This patient likely has placenta previa, which presents with painless vaginal bleeding in the third trimester. Digital or speculum examination is contraindicated due to the risk of severe bleeding. Ultrasound is the safest and best diagnostic test. A) Speculum examination → Incorrect. Never perform a speculum exam before ruling out placenta previa. B) Digital vaginal examination → Incorrect. Contraindicated due to risk of massive haemorrhage. C) Immediate cesarean section → Incorrect. Cesarean is needed if severe bleeding or fetal distress occurs, but this patient is stable. E) Administer anti-D immunoglobulin → Incorrect. Anti-D is needed only if the patient is Rh-negative, but first, you need a diagnosis. Key Tips for PLAB 1: ✅ Painless bleeding in late pregnancy → Suspect placenta previa. ✅ First-line test = Transabdominal ultrasound. ✅ Digital vaginal exam is CONTRAINDICATED before ruling out placenta previa.
