In placenta previa evaluation, which examination is contraindicated?

• A. Ultrasound
• B. Pelvic ultrasound
• C. Bimanual exam
• D. MRI

Answer: (C)

In placenta previa, manipulation of the cervix with a digital or internal exam can trigger heavy vaginal bleeding by disrupting placental tissue that is covering or near the internal os. This makes a bimanual exam contraindicated—adding risk of catastrophic hemorrhage before imaging has confirmed placental location.

Ultrasound is the safe, first-line method to identify placenta previa and locate the placenta relative to the os. MRI can be used as an adjunct if there’s concern for placental invasion (accreta) or when ultrasound is inconclusive. Pelvic ultrasound (imaging) similarly helps visualize placental position. If bleeding occurs, a speculum exam can assess the cervix without disturbing the placenta, but a digital internal exam should be avoided until imaging has ruled out previa.