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Question 113
Delivery suite → Haemorrhage
Classification
Question
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A woman at 35 weeks presents with abdominal pain, vaginal bleeding and uterine tenderness. Placental abruption is suspected. A Kleihauer test demonstrates no significant fetomaternal haemorrhage. Which interpretation is most appropriate?
Question Stem
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Options
A
A) Placental abruption is excluded
B
B) Ultrasound is now required to confirm the diagnosis
C
C) Placental abruption remains a clinical diagnosis
D
D) Abruption is excluded unless the test becomes positive within 24 hours
E
E) The presentation should be reclassified as placenta praevia
Explanation
The Kleihauer test is not a diagnostic test for placental abruption. Its principal role in APH is to quantify fetomaternal haemorrhage in RhD-negative women so that an appropriate additional dose of anti-D immunoglobulin can be determined. Placental abruption remains principally a clinical diagnosis based on symptoms, examination and maternal-fetal condition. Neither a negative Kleihauer test nor a normal ultrasound reliably excludes abruption.
Option Validity
A) A negative Kleihauer test does not exclude placental abruption.
B) Ultrasound may assist assessment but cannot reliably confirm or exclude abruption.
D) Serial Kleihauer positivity is not required to diagnose abruption.
E) A negative Kleihauer test does not establish placenta praevia.
Further Reading
RCOG Green-top Guideline No. 63. Antepartum Haemorrhage. Royal College of Obstetricians and Gynaecologists; 2011.