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Question 109
Delivery suite → Haemorrhage
Classification
Question
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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?
Question Stem
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Options
A
Corticosteroids are unlikely to be beneficial solely because of this resolved spotting
B
Corticosteroids are mandatory after any APH before 37 weeks
C
Give corticosteroids only if the Kleihauer test is positive
D
Give corticosteroids because all APH predicts delivery within 48 hours
E
Delay assessment until corticosteroids have been administered
Explanation
Antenatal corticosteroids should be offered to women with APH between 24+0 and 34+6 weeks when they are considered at increased risk of preterm birth. In contrast, corticosteroids are unlikely to be beneficial in a woman with isolated spotting that has stopped where there is no evidence suggesting an increased likelihood of preterm delivery. The decision therefore depends on the clinical assessment of preterm birth risk rather than the presence of any vaginal bleeding alone.
Option Validity
B) APH before 37 weeks does not automatically mandate corticosteroids.
C) Kleihauer testing assesses fetomaternal haemorrhage and does not determine corticosteroid eligibility.
D) Isolated APH does not mean that delivery within 48 hours is inevitable.
E) Appropriate maternal and fetal assessment should not be delayed for corticosteroid administration.
Further Reading
RCOG Green-top Guideline No. 63. Antepartum Haemorrhage. Royal College of Obstetricians and Gynaecologists; 2011.