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Question 139
Delivery suite → Haemorrhage
Classification
Question
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A woman at 35+2 weeks presents with suspected placental abruption. She has received initial resuscitation. Her blood pressure is 92/58 mmHg with persistent tachycardia. Vaginal bleeding continues. CTG shows recurrent prolonged decelerations. Ultrasound shows a normally situated placenta and no retroplacental collection. Which finding should have the least influence on the decision to expedite delivery?
Question Stem
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Options
A
Absence of a retroplacental collection on ultrasound
B
Persistent maternal cardiovascular compromise
C
Continuing haemorrhage
D
Recurrent prolonged fetal heart rate decelerations
E
Clinical suspicion of placental abruption
Explanation
This woman has clinical evidence of significant abruption with both maternal and fetal compromise. Delivery should be expedited while maternal resuscitation continues. The absence of a retroplacental collection on ultrasound should have little influence because ultrasound has poor sensitivity for placental abruption and a negative scan cannot exclude the diagnosis. Maternal cardiovascular instability, ongoing haemorrhage and pathological fetal heart rate abnormalities are direct indicators of severity and urgency.
Option Validity
B) Persistent maternal cardiovascular compromise is a major determinant of the urgency of management.
C) Continuing haemorrhage indicates an active obstetric emergency and is directly relevant to the decision to expedite delivery.
D) Recurrent prolonged fetal heart rate decelerations indicate significant fetal compromise and increase the urgency of delivery.
E) Placental abruption remains primarily a clinical diagnosis, so strong clinical suspicion remains highly relevant despite negative ultrasound findings.
Further Reading
RCOG Green-top Guideline No. 63. Antepartum Haemorrhage. Royal College of Obstetricians and Gynaecologists; 2011.