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?

A. Digital cervical examination
B. Biophysical profile
C. Pelvic ultrasound
D. Blood transfusion
E. Bed rest

Answer 1

The next step for the 19-year-old pregnant woman with vaginal bleeding is a pelvic ultrasound, as it safely assesses potential causes such as placenta previa or abruption without the risks associated with a digital cervical exam.

Step-by-step explanation:

The most appropriate next step in the management of the 19-year-old G1P0 woman with painless vaginal bleeding at 25 weeks gestation is to perform a pelvic ultrasound. This will help to determine the cause of the bleeding, such as placenta previa or abruption, without risking further disruption that could be caused by a digital cervical examination. A biophysical profile may also be important later on to assess the wellbeing of the fetus but does not supersede the immediate need to determine the etiology of the bleeding.

It is important to avoid a digital cervical examination until placental location is known, as it could potentially exacerbate bleeding if there is placenta previa. Given the patient's stable vital signs and lack of pain, a blood transfusion is not indicated at this time. Bed rest may be advised after the cause of bleeding is determined, to minimize further risks. Immediate action should focus on the diagnostic assessment to guide further management.