Placenta previa and vasa previa Quiz: Ace Your Exams
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A 32-year-old woman, gravida 4, para 3, presents to labor and delivery triage at 26 weeks of gestation with painless vaginal bleeding that began 2 hours ago. She has saturated about 50% of a pad already. An anatomy ultrasound at 20 weeks of gestation showed an anatomically normal fetus, a posterior placenta with the lower margin located 8 mm from the internal cervical os, a velamentous cord insertion, and umbilical vessels passing within 14 mm of the os. Her medical history is notable for three prior C-sections that were uncomplicated. Temperature is 36.5°C (97.8°F), pulse is 86/min, respirations are 18/min, and blood pressure is 118/78 mmHg. A speculum examination shows a very slow trickle of bright red blood coming from a closed cervical os. The fetal heart rate (FHR) tracing shows a baseline of 130/min with no accelerations or decelerations and a saw-tooth, sinusoidal pattern, and there are no contractions seen on the monitor. Which of the following is the most appropriate management plan?
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