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Question 133
Delivery suite → Haemorrhage
Classification
Question
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A 41-year-old multiparous woman at 30 weeks presents with painless APH. She has had three previous caesarean births and conceived spontaneously. Which feature in her history most directly increases the likelihood that placenta praevia underlies the bleeding?
Question Stem
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Options
A
Maternal age alone excludes placental abruption
B
Multiparity makes a cervical cause more likely than a placental cause
C
Previous caesarean births increase the risk of placenta praevia
D
Spontaneous conception substantially reduces the risk of placenta praevia
E
Painless bleeding is sufficient to establish the diagnosis without placental imaging
Explanation
Previous caesarean birth is an established risk factor for placenta praevia, and the risk increases with uterine scarring. Other recognised associations include previous placenta praevia, multiparity, advanced maternal age, multiple pregnancy, smoking, assisted conception and other causes of endometrial damage. The clinical presentation may raise suspicion, but placenta praevia should be confirmed by assessment of placental location rather than diagnosed from bleeding characteristics alone.
Option Validity
A) Advanced maternal age does not exclude placental abruption.
B) Multiparity is itself associated with placenta praevia and does not establish a cervical source of bleeding.
D) Spontaneous conception does not negate the increased risk associated with previous caesarean births.
E) Painless bleeding may raise suspicion of placenta praevia but does not establish placental location.
Further Reading
RCOG Green-top Guideline No. 63. Antepartum Haemorrhage. Royal College of Obstetricians and Gynaecologists; 2011.