Instruments or fingers should not be placed near the cervix during a vaginal examination, because uncontrolled bleeding can result. Do not perform vaginal or rectal examinations in an outpatient or emergency department setting unless ultrasonography findings have ruled out placenta previa.
Rarely, ultrasonography is unavailable and a digital examination is necessary. If this is the case, the digital examination should be performed in the operating room under double setup conditions (ie, one team ready for emergent cesarean delivery and one team ready for uneventful vaginal delivery).
Other problems to consider in a woman with suspected placenta previa include the following:
Cervical or vaginal laceration
Vaginal sidewall laceration
Miscarriage (spontaneous abortion)
Lower genital tract lesions
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