Previa Paula — Placenta Previa
Painless bright red bleeding — NEVER do a vaginal exam
Paula is folding laundry at 32 weeks when she feels a warm gush and finds bright red blood, with no cramping at all. She has felt completely fine all day.
Paula's placenta has implanted low in the uterus, partially or completely covering the cervix. As the lower segment thins in the third trimester, painless, bright red vaginal bleeding appears without warning. A digital vaginal exam can tear the placenta and cause catastrophic hemorrhage, so it is absolutely contraindicated until previa is ruled out by ultrasound. Management is expectant with bed rest and monitoring if bleeding is mild and the fetus is preterm, or cesarean delivery if bleeding is heavy or the fetus is mature.
Read Previa Paula's full story →The story arc
The setup
Paula's 20-week ultrasound noted a low-lying placenta, and now at 32 weeks the lower uterine segment is stretching thin.
The turn
She notices bright red spotting after intercourse, completely painless, with no contractions on the monitor.
The crisis
A sudden gush soaks her clothing, and in triage a well-meaning student prepares to do a vaginal exam before the chart is reviewed.
The save
The nurse stops the exam, confirms previa on ultrasound, places Paula on modified bed rest with continuous fetal monitoring, and prepares for cesarean birth since vaginal delivery is unsafe.
NCLEX study section — Placenta Previa
What this chapter is testing: the recognition cues, the numbers and the priority action.
Study section: Maternal & Newborn
Take this chapter into practice questions on the same topic.