## Why Option 1 is correct In placenta previa with antepartum hemorrhage at 24 weeks, the management protocol per Williams Obstetrics 26e includes: (1) admission for observation and hemodynamic monitoring; (2) IV access and blood bank notification (type and crossmatch); (3) betamethasone 12 mg IM × 2 doses 24 hours apart for fetal lung maturity (indicated between 24–34 weeks); and (4) magnesium sulfate for fetal neuroprotection if gestation < 32 weeks. Cervical length assessment (structure **D**) helps stratify risk and inform neuroprotection decisions. The assessment of cervical length in the context of preterm bleeding guides the intensity of fetal monitoring and neuroprotective interventions. ## Why each distractor is wrong - **Option 2**: Digital cervical examination is absolutely contraindicated in suspected placenta previa because it can provoke massive hemorrhage. Transvaginal ultrasound has already confirmed the diagnosis; no digital exam is needed or safe. - **Option 3**: Discharge home is inappropriate for confirmed placenta previa with active bleeding at 24 weeks. These patients require inpatient management, fetal monitoring, and access to emergency delivery if bleeding recurs or fetal compromise occurs. - **Option 4**: Cesarean delivery at 24 weeks is not indicated unless there is life-threatening hemorrhage or fetal distress. Elective cesarean for placenta previa is typically planned at 36–37 weeks (or earlier if recurrent bleeding). At 24 weeks, the priority is fetal maturation and hemorrhage control. **High-Yield:** Placenta previa + antepartum bleeding = admit, IV access, blood bank, steroids + neuroprotection; NEVER digital cervical exam; confirm diagnosis by transvaginal USG before any cervical manipulation. [cite: Williams Obstetrics 26e Ch 41]
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