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Question 100
Delivery suite → Haemorrhage
Classification
Question
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A woman at 33 weeks presents with painful vaginal bleeding, a tense tender uterus and fetal tachycardia. She reports recent recreational drug use. Which substance is particularly associated with placental abruption?
Question Stem
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Options
A
Cocaine
B
Paracetamol
C
Oral iron
D
Folic acid
E
Calcium carbonate
Explanation
Cocaine use is a recognised risk factor for placental abruption, probably related to its potent sympathomimetic and vasoconstrictive effects. In a woman presenting with painful APH, uterine tenderness and fetal compromise, recent cocaine exposure increases clinical suspicion for abruption. Management must nevertheless be determined by the maternal and fetal condition rather than waiting for toxicological confirmation.
Option Validity
B) therapeutic paracetamol use is not a recognised risk factor for placental abruption.
C) oral iron supplementation does not predispose to abruption.
D) folic acid is not associated with placental abruption.
E) calcium carbonate is not a recognised risk factor for abruption.
Further Reading
RCOG Green-top Guideline No. 63. Antepartum Haemorrhage. Royal College of Obstetricians and Gynaecologists; 2011.