SBA — Single Best Answer · Review
Question 117
Delivery suite → Haemorrhage
Classification
Question
SSBAQuestion Header
A woman with APH requires operative delivery. She is haemodynamically stable, her bleeding has stopped and laboratory investigations show no evidence of coagulopathy. Which statement regarding regional anaesthesia is most appropriate?
Question Stem
—
Options
A
A) Regional anaesthesia is absolutely contraindicated after any APH
B
B) General anaesthesia is mandatory whenever placental abruption is suspected
C
C) Regional anaesthesia can be considered when the woman is stable and there is no coagulopathy
D
D) Regional anaesthesia is permitted only after delivery of the placenta
E
E) Epidural analgesia should be avoided solely because antenatal bleeding occurred
Explanation
A history of APH does not itself constitute an absolute contraindication to regional anaesthesia. The anaesthetic technique should be individualised according to maternal haemodynamic status, urgency of delivery and the presence or absence of coagulopathy. Regional techniques may be appropriate in a stable woman without haemostatic disturbance. In contrast, major ongoing haemorrhage, cardiovascular instability or significant coagulopathy may necessitate a different anaesthetic approach.
Option Validity
A) APH itself is not an absolute contraindication to regional anaesthesia.
B) Suspected abruption does not automatically mandate general anaesthesia in every patient.
D) Regional anaesthesia does not require prior delivery of the placenta.
E) Previous antenatal bleeding alone is insufficient reason to prohibit an epidural technique.
Further Reading
RCOG Green-top Guideline No. 63. Antepartum Haemorrhage. Royal College of Obstetricians and Gynaecologists; 2011.