With painless vaginal bleeding at 37 weeks gestation, which of the following measures in immediately indicated?
With painless vaginal bleeding at 37 weeks gestation, there is no longer a danger of delivering a premature infant, but there may be a question about the diagnosis. Rupture of the membranes, induction of labor, and cesarean section all imply that the diagnosis of placenta previa is without question and that delivery is indicated. Both induction of labor and rupture of membranes could lead to excessive bleeding if placenta previa were present. There is no need to do an immediate coagulation profile with suspected placenta previa, as changes in coagulation occur in abruptio placentae. The most important aspect of painless vaginal bleeding is its cause, which may not be placenta previa; therefore, a speculum examination of the vagina is immediately indicated to rule out cervical and vaginal causes of the bleeding.
