Which immediate diagnostic step is most important for a patient at 15 weeks' gestation with dark brown vaginal bleeding and high blood pressure?

Which immediate diagnostic step is most important for a patient at 15 weeks' gestation with dark brown vaginal bleeding and high blood pressure?

• A. Stat ultrasound
• B. Urinalysis
• C. CBC
• D. Vitamin K level

Answer: (A)

In midtrimester bleeding with new hypertension, the priority is to quickly determine the placenta’s location and fetal status to identify causes like placenta previa or placental abruption and to assess fetal viability. A stat ultrasound provides real-time information about where the placenta sits, whether there are signs of placental separation or a retroplacental hematoma, and whether the fetus is alive and tracing. This imaging directly guides immediate management decisions, such as monitoring intensity, need for transfer, or delivery planning if the situation worsens. Urinalysis helps screen for preeclampsia but doesn’t tell you the bleeding source or placental anatomy. CBC can reveal anemia or infection but again doesn’t address the acute cause of bleeding. Vitamin K level has no role in evaluating antepartum bleeding.

In midtrimester bleeding with new hypertension, the priority is to quickly determine the placenta’s location and fetal status to identify causes like placenta previa or placental abruption and to assess fetal viability. A stat ultrasound provides real-time information about where the placenta sits, whether there are signs of placental separation or a retroplacental hematoma, and whether the fetus is alive and tracing. This imaging directly guides immediate management decisions, such as monitoring intensity, need for transfer, or delivery planning if the situation worsens.

Urinalysis helps screen for preeclampsia but doesn’t tell you the bleeding source or placental anatomy. CBC can reveal anemia or infection but again doesn’t address the acute cause of bleeding. Vitamin K level has no role in evaluating antepartum bleeding.