The very last!!! - mos11

[ArchivalUser]

A 22-year-old G1 P0 woman at 34 weeks™ gestation presents with moderate
vaginal bleeding and no uterine contractions. Her blood pressure
(BP) is 110/60 mm Hg and heart rate (HR) 103 beats per minute (bpm).
The abdomen is nontender. Which of the following sequence of examinations
is most appropriate?
A. Speculum examination, ultrasound examination, digital examination
B. Ultrasound examination, digital examination, speculum examination
C. Digital examination, ultrasound examination, speculum examination
D. Ultrasound examination, speculum examination, digital examination

[ArchivalUser]

b..

[ArchivalUser]

DD??

[ArchivalUser]

D)Ultrasound should be performed first to rule out previa, speculum
examination second to assess the cervix and look for lacerations, and
finally digital examination. Performing either a speculum examination
or digital examination before evaluating the patient with ultrasound
puts the patient at risk for hemorrhage. In the setting of a
previa, the lower uterine segment and cervix are highly vascularized,
and varices of the cervix may be visualized on speculum examination
in some situations; however, the speculum itself may cause trauma to
these varices and induce bleeding. A blind digital examination may
result in further separation of the placenta from the uterus, which
could also cause significant bleeding.