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Question 141
Delivery suite → Haemorrhage
Classification
Question
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A woman at 29 weeks has an unexplained APH requiring admission. Placenta praevia is excluded, the bleeding settles and no definitive cause is identified. At 31 weeks she remains asymptomatic and fetal biometry is appropriate for gestational age. Which subsequent management most appropriately addresses the important residual fetal risk?
Question Stem
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Options
A
Return immediately to routine low-risk care because fetal growth is currently normal
B
Serial ultrasound surveillance of fetal growth
C
Daily CTG until delivery despite remaining asymptomatic
D
Weekly Kleihauer testing to screen for developing fetal growth restriction
E
Elective caesarean birth at 34 weeks to prevent late fetal growth restriction
Explanation
Unexplained APH is associated with adverse pregnancy outcomes, including fetal growth restriction and preterm birth. Once the immediate episode has resolved, the pregnancy should therefore not automatically return to routine low-risk care. Serial ultrasound assessment of fetal growth is appropriate because a normally grown fetus shortly after the bleeding episode does not exclude later growth impairment. Routine daily CTG, serial Kleihauer testing and preterm elective caesarean delivery do not constitute appropriate surveillance for this risk.
Option Validity
A) Normal fetal growth shortly after the bleeding episode does not remove the subsequent increased risk of fetal growth restriction.
C) Daily cardiotocography is not the appropriate longitudinal screening strategy for fetal growth restriction in an otherwise stable pregnancy.
D) The Kleihauer test quantifies fetomaternal haemorrhage and is not a surveillance test for fetal growth restriction.
E) Unexplained antepartum haemorrhage alone does not justify elective preterm caesarean birth solely to prevent possible later fetal growth restriction.
Further Reading
RCOG Green-top Guideline No. 63. Antepartum Haemorrhage. Royal College of Obstetricians and Gynaecologists; 2011.