Management of Placenta Previa: What to Avoid
Direct Answer
In placenta previa, both digital vaginal examination and sexual intercourse should be avoided, while maintaining adequate oral intake is essential. 1, 2
Critical Contraindications
Digital Vaginal Examination - ABSOLUTELY CONTRAINDICATED
- Digital pelvic examination must be avoided until placenta previa has been excluded, as it can trigger life-threatening hemorrhage. 1, 2
- This is a fundamental safety principle emphasized across all major guidelines - the digital examination can mechanically disrupt the abnormally positioned placenta and precipitate catastrophic bleeding. 3, 4
- Transvaginal ultrasound is the gold standard for diagnosis (90.7% sensitivity, 96.9% specificity) and should be used instead of digital examination for assessment. 1
Sexual Intercourse - Should Be Avoided
- Sexual intercourse should be avoided in women with placenta previa, particularly after 28 weeks of gestation when activity restrictions become more stringent. 1, 2
- While not explicitly stated in all guidelines with the same emphasis as digital examination, the mechanical stimulation and potential for bleeding make this a prudent restriction given the underlying pathophysiology.
- Women with placenta previa should avoid moderate-to-vigorous physical activity after 28 weeks but can maintain activities of daily living and low-intensity activity such as walking. 1, 2
Oral Intake - SHOULD NOT BE DECREASED
- Decreased oral intake is NOT recommended and is actually contraindicated. Adequate nutrition and hydration are essential throughout pregnancy with placenta previa.
- Hemoglobin values should be maximized during pregnancy by treating anemia with oral or intravenous iron as needed to prepare for potential hemorrhage at delivery. 1, 2
- Maintaining adequate oral intake supports optimal maternal hemoglobin levels, which is critical given the high risk of hemorrhage in placenta previa. 4
Activity Modification Algorithm
Before 28 weeks:
- Continue moderate-to-vigorous physical activity if asymptomatic. 1, 2
- Avoid digital vaginal examination. 1, 2
After 28 weeks:
- Avoid moderate-to-vigorous physical activity. 1, 2
- Maintain activities of daily living and low-intensity activity such as walking. 1, 2
- Avoid sexual intercourse.
- Continue adequate oral intake with iron supplementation as needed. 1, 2
With active bleeding:
- Hospitalization is required. 1, 2
- Strict avoidance of any vaginal examination or instrumentation. 1, 2
Common Pitfalls
- Never perform a digital examination "just to check" in a patient with known or suspected placenta previa - this single action can precipitate massive hemorrhage requiring emergency cesarean delivery. 1, 2
- Do not restrict oral intake or nutrition in an attempt to "prepare for surgery" - these patients need optimal hemoglobin levels and should be actively treated for anemia. 1, 2
- Bleeding with placenta previa is usually associated with uterine contractions, making any activity that could stimulate contractions (including sexual intercourse) potentially dangerous. 4