SBA — Single Best Answer · Review
Question 111
Delivery suite → Haemorrhage
Classification
Question
SSBAQuestion Header
A woman at 35 weeks is involved in a road traffic collision and sustains blunt abdominal trauma. She subsequently develops abdominal pain and uterine tenderness with only minimal vaginal bleeding. Which diagnosis should be specifically considered?
Question Stem
—
Options
A
Vasa praevia
B
Placental abruption
C
Cervical ectropion
D
Placenta accreta spectrum
E
Uterine inversion
Explanation
Abdominal trauma is a recognised risk factor for placental abruption. Following significant trauma, placental separation may occur and bleeding can be partly or predominantly concealed. Consequently, minimal visible vaginal bleeding does not exclude clinically important abruption. New abdominal pain, uterine tenderness or increased tone and fetal heart rate abnormalities after trauma should heighten suspicion and prompt appropriate maternal and fetal assessment.
Option Validity
A) Vasa praevia is not the characteristic consequence of blunt abdominal trauma described here.
C) Cervical ectropion may cause contact bleeding but does not explain the painful tender uterus after trauma.
D) Placenta accreta spectrum is related to abnormal placental adherence rather than acute traumatic placental separation.
E) Uterine inversion is principally a postpartum emergency and does not fit this antenatal presentation.
Further Reading
RCOG Green-top Guideline No. 63. Antepartum Haemorrhage. Royal College of Obstetricians and Gynaecologists; 2011.