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Question 112
Delivery suite → Haemorrhage
Classification
Question
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A woman has an unexplained major APH at 28 weeks. Placenta praevia is excluded and no definitive cause is identified. The bleeding settles and fetal assessment is reassuring. How should the pregnancy subsequently be regarded?
Question Stem
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Options
A
Low risk once bleeding has stopped for 24 hours
B
Low risk if maternal haemoglobin remains normal
C
High risk only if another episode occurs
D
Routine care is sufficient if ultrasound shows no abruption
E
High risk because unexplained APH is associated with adverse pregnancy outcomes
Explanation
A pregnancy complicated by unexplained APH should be reclassified as high risk because such bleeding is associated with adverse outcomes, including fetal growth restriction and preterm birth. Appropriate consultant-led or increased antenatal surveillance should therefore be considered, including serial assessment of fetal growth. A normal ultrasound does not exclude placental abruption and does not remove the prognostic significance of significant unexplained APH.
Option Validity
A) Cessation of bleeding does not remove the increased subsequent pregnancy risk.
B) A normal maternal haemoglobin does not negate the obstetric risks associated with unexplained APH.
C) Increased risk exists after the significant unexplained episode and does not require recurrence.
D) Normal ultrasound cannot exclude abruption and does not justify automatic return to routine low-risk care.
Further Reading
RCOG Green-top Guideline No. 63. Antepartum Haemorrhage. Royal College of Obstetricians and Gynaecologists; 2011.