Before performing a vaginal exam when placenta previa is suspected, what critical step should be taken?

• A. Start antibiotics before confirming
• B. Schedule cesarean delivery immediately
• C. Proceed with vaginal exams and confirm placental position
• D. Avoid vaginal exams and obtain ultrasound confirmation; consult OB

Answer: (D)

When placenta previa is suspected, the priority is to avoid any vaginal examination that could provoke bleeding. The placenta positioned near or over the cervical canal means digital or vaginal probing risks heavy hemorrhage. The safest next step is to confirm placental location with ultrasound, which is noninvasive and accurately shows whether the placenta covers the os or is normal. After ultrasound confirmation, involve obstetrics to plan management, often including delivery by cesarean if previa is present. Antibiotics or immediate cesarean based only on suspicion aren’t warranted; imaging and specialist input guide the appropriate course of action.