RN Nursing · High-Risk Pregnancy — Placenta Previa · Practice question
A nurse is caring for a client who is at 37 weeks of gestation and has placenta previa. The client asks the nurse why the provider does not do an internal examination. Which of the following explanations of the primary reason should the nurse provide?
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"This could initiate preterm labor."
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"There is an increased risk of introducing infection."
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✓
"This could result in profound bleeding."
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“There is an increased risk of rupture of the membranes."
Answer & explanation
Correct: "This could result in profound bleeding."
In placenta previa, the placenta implants over or near the internal cervical os. When an internal (digital or speculum) examination is performed, the examiner's fingers can disrupt the placental tissue lying directly over the cervix, causing immediate and potentially life-threatening hemorrhage. This is why vaginal examinations are strictly contraindicated in known or suspected placenta previa, and ultrasound is used instead to assess cervical length and placental location. The phrase "profound bleeding" accurately captures this primary danger. While infection risk is always a consideration during any vaginal examination, it is not the principal reason the provider avoids internal examination in this situation. Rupture of membranes is a concern with certain procedures but is not the driving rationale here. Initiating preterm labor is also not the main concern; at 37 weeks the client is near term, and the risk of catastrophic hemorrhage from disrupting a low-lying placenta vastly outweighs the other listed concerns. Understanding this pathophysiology helps the nurse explain the safety rationale clearly to the client and reinforces why any vaginal bleeding in placenta previa is treated as a medical emergency requiring prompt evaluation without internal examination.
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