APH — Placenta Previa

A 32-year-old primigravida at 34 weeks of gestation presents to the emergency department with painless vaginal bleeding of 200 mL. She denies abdominal pain, contractions, or leakage of fluid. Vital signs are stable (BP 128/82, HR 88, RR 18). On speculum examination, blood is seen pooling in the vagina with no cervical source identified. Transabdominal ultrasound confirms a placenta covering the internal cervical os. What is the most appropriate immediate management?

A 28-year-old primigravida at 28 weeks of gestation presents with 300 mL of vaginal bleeding. She is hemodynamically stable (BP 118/76 mmHg, HR 88 bpm). Transvaginal ultrasound confirms placenta previa with the lower placental edge 1.5 cm above the internal cervical os. She is admitted for expectant management. On day 5 of hospitalization, she develops sudden onset of heavy vaginal bleeding (estimated 600 mL in 30 minutes) with hemoglobin drop from 10.2 to 8.5 g/dL. Fetal heart rate is 155 bpm with decreased variability. What is the most appropriate next step?

A 28-year-old multiparous woman (G3P2) at 29 weeks of gestation is brought to the hospital with heavy vaginal bleeding (estimated 400 mL) and severe lower abdominal pain. On examination, she is anxious, BP 100/62, HR 110, RR 22. Uterus is tender and rigid. Speculum examination shows blood pooling in the vagina with no cervical lesion. Ultrasound confirms a placenta completely covering the internal cervical os with a large retroplacental clot. Fetal heart rate is 145 bpm. What is the most appropriate next step?

A 32-year-old primigravida at 28 weeks of gestation presents to the antenatal clinic with painless vaginal bleeding. On speculum examination, no cervical source is identified. What is the investigation of choice to confirm the diagnosis of placenta previa?

A 28-year-old multigravida at 34 weeks of gestation presents with recurrent episodes of painless vaginal bleeding. Transabdominal ultrasound shows the placenta partially covering the internal cervical os. The patient is hemodynamically stable and the fetus is in cephalic presentation. Which investigation is most appropriate to assess placental invasion and guide management?