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Question 135
Delivery suite → Haemorrhage
Classification
Question
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A nulliparous woman asks whether placental abruption can be reliably predicted because she has none of the recognised clinical risk factors. Which counselling statement is most accurate?
Question Stem
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Options
A
Absence of hypertension makes subsequent abruption extremely unlikely
B
A normal placental ultrasound effectively identifies women who will not develop abruption
C
Abruption is predictable only after 34 weeks
D
Most abruptions occur in women with a previous placental abruption
E
Risk-factor assessment cannot reliably predict APH because many abruptions occur in otherwise low-risk pregnancies
Explanation
Although numerous risk factors for placental abruption are recognised, their absence cannot reliably identify women who will remain unaffected. The RCOG guideline emphasises that APH cannot be reliably predicted and that a substantial proportion of placental abruptions occur in women considered low risk. Previous abruption is an important individual risk factor, but most women who ultimately develop abruption cannot be identified prospectively by a sufficiently accurate screening strategy.
Option Validity
A) Placental abruption may occur in women without hypertension or pre-eclampsia.
B) A normal placental ultrasound is not a reliable screening method for predicting subsequent placental abruption.
C) There is no gestational threshold after which placental abruption becomes reliably predictable.
D) Previous placental abruption increases recurrence risk substantially but does not account for most subsequent cases of abruption.
Further Reading
RCOG Green-top Guideline No. 63. Antepartum Haemorrhage. Royal College of Obstetricians and Gynaecologists; 2011.