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Question 110
Delivery suite → Haemorrhage
Classification
Question
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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?
Question Stem
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Options
A
Caesarean birth must occur immediately at 36 weeks
B
Pregnancy must continue to 42 weeks irrespective of further bleeding
C
Delivery at 37 weeks is mandatory after any APH
D
Timing of delivery should be individualised because evidence for elective delivery after stable unexplained APH is limited
E
Delivery is contraindicated until spontaneous labour begins
Explanation
When APH has settled and there is no maternal or fetal compromise, the optimal timing of delivery is not determined by a universal gestational threshold. Management should be individualised according to the underlying cause, severity and recurrence of bleeding, gestation and maternal and fetal condition. Immediate delivery is required when maternal or fetal compromise occurs, but a stable pregnancy following resolved APH does not automatically require either immediate birth or a fixed elective delivery date.
Option Validity
A) Resolved APH with reassuring maternal and fetal status does not automatically require immediate caesarean birth.
B) Further maternal or fetal complications may require earlier delivery.
C) There is no universal rule requiring delivery at exactly 37 weeks after every APH.
E) Elective delivery may be appropriate in selected circumstances and is not prohibited before spontaneous labour.
Further Reading
RCOG Green-top Guideline No. 63. Antepartum Haemorrhage. Royal College of Obstetricians and Gynaecologists; 2011.