What should be avoided in placenta previa: digital exam, sexual intercourse, or decreased oral intake?

What Should Be Avoided in Placenta Previa

Both digital vaginal examination and sexual intercourse should be avoided in placenta previa, while decreased oral intake is not a relevant restriction.

Digital Vaginal Examination - MUST BE AVOIDED

• Digital pelvic examination must be completely avoided until placenta previa has been excluded, as it can trigger life-threatening hemorrhage 1, 2, 3
• This is a critical safety measure because digital examination can mechanically disrupt the placenta overlying the cervical os, causing catastrophic bleeding 4, 3
• Transvaginal ultrasound is safe and is actually the gold standard diagnostic modality, with 90.7% sensitivity and 96.9% specificity 4, 3
• The prohibition on digital examination remains in effect throughout pregnancy until placenta previa is definitively ruled out 1

Sexual Intercourse - SHOULD BE AVOIDED

• Sexual intercourse should be avoided in women with placenta previa, particularly after 28 weeks gestation 2
• This falls under the broader category of avoiding moderate-to-vigorous physical activity after 28 weeks 2, 4, 3
• Before 28 weeks, women with asymptomatic placenta previa can continue moderate-to-vigorous physical activity, but this changes as pregnancy progresses 2, 4
• After 28 weeks, only activities of daily living and low-intensity activity such as walking should be maintained 2, 4, 3

Decreased Oral Intake - NOT RELEVANT

• There is no recommendation to decrease oral intake in placenta previa 2, 4, 3
• In fact, the opposite approach is recommended: hemoglobin values should be maximized during pregnancy by treating anemia with oral or intravenous iron as needed 2, 3
• Adequate nutrition and iron supplementation are essential to prepare for potential hemorrhage at delivery 3

Additional Critical Restrictions

• Hospitalization is required for any woman with active bleeding 2, 4
• Women with placenta previa should be delivered at a level III or IV maternal care facility with adequate blood banking facilities and multidisciplinary expertise 3
• Planned cesarean delivery at 34 0/7 to 35 6/7 weeks gestation is recommended for uncomplicated placenta previa 4, 3

Common Pitfall to Avoid

• Failure to avoid digital examination without first excluding placenta previa can lead to catastrophic hemorrhage and is a preventable cause of maternal morbidity 4, 3