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Question 121
Delivery suite → Haemorrhage
Classification
Question
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A woman at 30+2 weeks presents with vaginal bleeding and painful uterine contractions. Placental abruption is suspected clinically. Maternal observations are currently stable and CTG is reassuring. The cervix is 2 cm dilated. Which factor would most strongly argue against using tocolysis?
Question Stem
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Options
A
A) Gestation below 34 weeks
B
B) Cervical dilatation of 2 cm
C
C) Reassuring fetal heart rate at presentation
D
D) Eligibility for antenatal corticosteroids
E
E) Evidence that bleeding represents placental abruption
Explanation
Tocolysis in the setting of APH requires considerable caution. RCOG states that tocolysis should not be used to delay delivery when maternal or fetal compromise is present and identifies placental abruption as a contraindication to tocolysis. Although prolongation of pregnancy might theoretically permit corticosteroid benefit at this gestation, suspected abruption changes the risk-benefit balance because suppressing uterine activity may delay necessary delivery in a condition capable of rapid maternal and fetal deterioration.
Option Validity
A) Prematurity itself is one reason to consider pregnancy prolongation in appropriately selected women, not a contraindication.
B) Limited cervical dilatation alone is not the decisive contraindication presented here.
C) A reassuring CTG does not remove the contraindication created by suspected abruption.
D) Potential corticosteroid benefit may favour prolongation in suitable cases but does not override a contraindication to tocolysis.
Further Reading
RCOG Green-top Guideline No. 63. Antepartum Haemorrhage. Royal College of Obstetricians and Gynaecologists; 2011.