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Question 102
Delivery suite → Haemorrhage
Classification
Question
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A woman at 35+6 weeks presents with placental abruption. She has received initial resuscitation and is currently haemodynamically stable. CTG demonstrates persistent severe fetal compromise. The cervix is 3 cm dilated and vaginal birth is not imminent. What is the most appropriate next step?
Question Stem
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Options
A
Continue observation until full cervical dilatation
B
Commence oxytocin and reassess after two hours
C
Perform emergency caesarean section
D
Commence tocolysis
E
Repeat ultrasound to demonstrate a retroplacental clot
Explanation
When APH is associated with fetal compromise, delivery should be expedited. If the fetus is alive and vaginal birth is not imminent, caesarean section is generally the appropriate route of delivery. Maternal resuscitation should continue concurrently. Waiting for cervical dilatation, administering tocolysis or delaying delivery for imaging would expose the fetus to ongoing hypoxia. Ultrasound confirmation is unnecessary because placental abruption is principally a clinical diagnosis.
Option Validity
A) persistent severe fetal compromise requires expedited delivery rather than expectant management.
B) oxytocin with delayed reassessment would create inappropriate delay when vaginal birth is not imminent.
D) tocolysis is contraindicated when fetal compromise requires delivery.
E) ultrasound confirmation of abruption is unnecessary and would delay indicated delivery.
Further Reading
RCOG Green-top Guideline No. 63. Antepartum Haemorrhage. Royal College of Obstetricians and Gynaecologists; 2011.