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Question 101
Delivery suite → Haemorrhage
Classification
Question
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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?
Question Stem
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Options
A
Tocolysis is mandatory in every woman with APH before 34 weeks
B
Tocolysis is absolutely contraindicated after any vaginal bleeding
C
Tocolysis may be considered selectively under senior obstetric supervision
D
Tocolysis should be continued until 37 weeks
E
Tocolysis should be commenced before establishing the cause of bleeding
Explanation
Tocolysis is not routinely indicated for all women with APH, but it may be considered in selected cases when preterm delivery is threatened and there is no maternal or fetal indication for immediate delivery. Such decisions require senior obstetric input because APH may reflect placental abruption or another condition in which prolonging pregnancy could be hazardous. Tocolysis should not be used when maternal or fetal compromise requires delivery.
Option Validity
A) APH before 34 weeks does not automatically mandate tocolysis.
B) APH is not an absolute contraindication in every clinical circumstance.
D) tocolysis is not intended to maintain pregnancy routinely until term.
E) assessment of the bleeding and maternal-fetal condition is necessary before considering tocolysis.
Further Reading
RCOG Green-top Guideline No. 63. Antepartum Haemorrhage. Royal College of Obstetricians and Gynaecologists; 2011.