This question essentially is about recognising the high risk of this patient
In thie primigravida with U/S evidence of low lying placenta now presenting with H/O vaginal bleeding about 12 hrs ago the differential diagnosis should include Placental abruption, plavcenta previa and the other non prgenancy related causes like trauma, cervical polyp etc. Rare causes like vasa previa should be conisdered but very rare
Ask about pain, amount of blood and colour.
Confirm whether it is the first time
Rule out other medical conditions in the history
Rule out previous U/S findings and antenatal clinic visits, and rule out twins from history
O/E vital signs,
Gentle abdominal examination for uterine check ( usually not tender in previa), FHR.
NO VAGINAL Examination should be performed until U/S examination done to rule out placenta previa and abruption and rule out ongoing bleeding.
If vital signs are normal then arrange U/S
Collect blood samples for FBE, Groupd & cross match , coagulation profile, feto-maternal hemorrhage test
Above 24 weeks, consider steroid injection
CTG monitoring to check fetal status
Anti RhD immunoglobulin if Rh negative
Maternal monitoring
Bed rest and obstetrician review
For previa- should book OT for urgent semil elective - C/S
For abruption- if no fetal distress and no ongoing major hemorrhage the induction of labour under close monitoring for fetal distress is an option
