Question

A 19-year-old G1P0 woman presents to the hospital at 25 weeks gestation with vaginal bleeding for the past hour. She had intercourse earlier without discomfort. Currently she denies cramping or pain and feels the baby moving. Her prenatal course has been uncomplicated. She takes no medication besides prenatal vitamins and denies smoking, alcohol or drug use. Her vital signs are: blood pressure 110/70; pulse 68; and she is afebrile. Her abdomen and uterus are soft and non-tender. Fetal heart tones are in the 150s. Which of the following is the most appropriate next step in the management of this patient?

1) Digital cervical examination
2) Biophysical profile
3) Pelvic ultrasound
4) Blood transfusion
5) Bed rest

Answer 1

The most appropriate next step for a pregnant woman presenting with vaginal bleeding and stable vitals, with no pain or abdominal tenderness, is to perform a pelvic ultrasound to assess the source of bleeding.

Step-by-step explanation:

A 19-year-old G1P0 woman presents to the hospital at 25 weeks gestation with vaginal bleeding but otherwise has an uncomplicated prenatal course and shows no signs of distress or pain. Considering her situation and vital signs are stable, along with the absence of pain or tenderness in her abdomen and uterus, the most appropriate next step in management is a pelvic ultrasound. A digital cervical examination is avoided initially as it could potentially cause further bleeding if a placenta previa or low-lying placenta is present. A biophysical profile is typically not the immediate next step for assessing acute vaginal bleeding. Blood transfusion is not indicated in the absence of significant blood loss or hemodynamic instability, and while bed rest might be advised later, it is not a diagnostic measure.