A 40-year-old female is 38 weeks pregnant with severe abdominal pain and dark red vaginal bleeding. After administering oxygen, what is the next action?

• A. Place her in the knee-chest position.
• B. Keep her warm.
• C. Pack her vagina with sterile dressings.
• D. Place her supine with her feet elevated.

Answer: (C)

In OB emergencies with heavy vaginal bleeding, the immediate focus is to control hemorrhage while you continue monitoring and transport. Packing the vagina with sterile dressings provides immediate hemostasis and absorption of blood, helping to limit further blood loss and keep the patient more stable as you prepare for definitive care. It also helps prevent pooling of blood in the birth canal and reduces contamination risk.

Other options don’t address the bleeding directly. A knee-chest position isn’t indicated here and can be uncomfortable without improving perfusion. Keeping the patient warm is important, but it doesn’t resolve the active bleeding. Placing her supine with her feet elevated can worsen venous return problems due to aortocaval compression in late pregnancy, potentially decreasing blood pressure and perfusion. Packing the vagina is the most direct step to manage the hemorrhage in this situation.