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Question 115
Delivery suite → Haemorrhage
Classification
Question
SSBAQuestion Header
A woman at 36 weeks presents with vaginal bleeding. Which additional symptom most strongly increases clinical suspicion of placental abruption?
Question Stem
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Options
A
A) Constant abdominal pain
B
B) Pruritus of the palms
C
C) Painless urinary frequency
D
D) Heartburn after meals
E
E) Increased vaginal discharge for several weeks
Explanation
Placental abruption commonly presents with vaginal bleeding accompanied by abdominal or back pain, uterine tenderness and increased uterine tone. The haemorrhage may be partly or completely concealed, so the amount of visible bleeding does not reliably indicate severity. Constant abdominal pain accompanying APH should therefore substantially increase suspicion of abruption and prompt careful assessment of maternal condition, uterine findings and fetal wellbeing.
Option Validity
B) Pruritus is not a characteristic presenting feature of placental abruption.
C) Painless urinary frequency is not a characteristic symptom of placental abruption.
D) Heartburn does not increase clinical suspicion of placental abruption.
E) Chronic increased vaginal discharge does not provide the characteristic painful presentation associated with placental abruption.
Further Reading
RCOG Green-top Guideline No. 63. Antepartum Haemorrhage. Royal College of Obstetricians and Gynaecologists; 2011.