Antepartum haemorrhage – management and delivery

A woman at 32+4 weeks presents with a moderate antepartum haemorrhage. Bleeding has settled following initial assessment, but the obstetric team considers her at increased risk of preterm delivery. Which intervention is most appropriate?

A woman at 37 weeks presents with a significant placental abruption. Maternal resuscitation has commenced. CTG demonstrates persistent fetal bradycardia and vaginal examination shows that vaginal birth is not imminent. What is the most appropriate obstetric management?

A woman at 31+5 weeks presents with painful uterine contractions and antepartum haemorrhage. Placental abruption is suspected. CTG demonstrates persistent fetal compromise. Which statement regarding tocolysis is most appropriate?

A woman at 35+2 weeks presents with an episode of antepartum haemorrhage greater than spotting. Maternal observations and CTG are reassuring, but she continues to have a small amount of vaginal bleeding. What is the most appropriate disposition?

A woman at 30 weeks reports a single episode of minimal vaginal spotting. Placenta praevia has been excluded. The bleeding has completely stopped, maternal observations are normal and fetal assessment is reassuring. No other risk factors are identified. Which management is most appropriate?

A woman at 30+3 weeks presents with a small antepartum haemorrhage and regular uterine contractions. Maternal observations are normal, CTG is reassuring and there is no evidence that immediate delivery is required. Corticosteroids have been commenced. Which statement best describes the use of tocolysis?

A woman at 33+1 weeks reports a single episode of light spotting after intercourse. The bleeding has stopped. Placenta praevia has been excluded, the cervix appears normal, there are no contractions and there is no evidence that preterm birth is likely. What is the most appropriate approach to antenatal corticosteroids?

A woman at 36+3 weeks had an unexplained APH at 34 weeks. There has been no further bleeding. Fetal growth, liquor volume and CTG are reassuring, and she remains clinically well. Which statement best describes planning the timing of birth?

A woman at 29+4 weeks presents with APH and regular painful contractions. Placenta praevia has been excluded. She has received the first dose of antenatal corticosteroids. Initially her observations and CTG were reassuring, and selective tocolysis was being considered. Thirty minutes later the bleeding increases, her pulse rises to 122 beats/min and the CTG develops recurrent late decelerations. What is the most appropriate modification of the management plan?

A woman at 33+4 weeks has her second episode of unexplained APH in 10 days. Each episode has been approximately 40 mL. The current bleeding has stopped, maternal observations are normal, CTG is reassuring and placenta praevia has been excluded. She asks to be discharged immediately because each individual episode meets the volume definition of minor haemorrhage. Which factor most strongly argues against basing discharge solely on the volume of the current episode?

A woman at 28+6 weeks presents with 60 mL APH and regular contractions. Placenta praevia has been excluded. She is haemodynamically stable, the uterus is soft between contractions and CTG is reassuring. There is no clinical evidence of placental abruption. The cervix has changed from 1 cm to 2 cm over two hours. She has received her first dose of antenatal corticosteroids. Which is the most defensible management regarding tocolysis?

Two women at 32 weeks are assessed following APH. Both currently have normal observations and reassuring fetal assessment. Woman X had a single episode of spotting that stopped before assessment; placenta praevia has been excluded and no further bleeding occurs. Woman Y has had three episodes of unexplained bleeding over seven days, the most recent being 40 mL earlier today. Which distinction most appropriately influences disposition?

A woman at 32+6 weeks presents to a midwifery-led unit with 250 mL APH. Her pulse is 108 beats/min, blood pressure 104/66 mmHg and the fetal heart is present. Bleeding has slowed after initial assessment. The unit has no on-site blood bank, anaesthetic service or facility for emergency caesarean birth. Which management plan best reflects the guideline?