SBA — Single Best Answer · Review
Question 142
Delivery suite → Haemorrhage
Classification
Question
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A woman planning another pregnancy previously had a placental abruption complicated by fetal growth restriction. She asks whether identifying and eliminating all recognised modifiable risk factors would make recurrence negligible. She does not smoke, use recreational drugs or have hypertension. Which is the most appropriate counselling?
Question Stem
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Options
A
Absence of current modifiable risk factors returns her risk to that of a woman with no previous abruption
B
A normal first-trimester ultrasound will reliably exclude recurrence later in pregnancy
C
Prophylactic delivery before 34 weeks is required because recurrence cannot be prevented
D
Recurrence occurs only when the original precipitating risk factor remains present
E
Previous placental abruption itself remains an important risk factor, and recurrence cannot be reliably excluded by absence of other recognised risks
Explanation
Previous placental abruption is one of the strongest recognised risk factors for a subsequent abruption. Modification of avoidable risks such as smoking and recreational drug use is appropriate, but the absence of these factors does not return a woman with previous abruption to baseline risk. More broadly, APH and abruption cannot be reliably predicted, and many cases occur without an identifiable preventable risk factor. Counselling should therefore distinguish useful risk-factor modification from an unrealistic expectation that recurrence can be excluded.
Option Validity
A) Previous placental abruption itself confers increased recurrence risk even when recognised modifiable risk factors are absent.
B) A normal first-trimester ultrasound cannot reliably predict or exclude placental abruption later in pregnancy.
C) A history of placental abruption does not itself mandate routine delivery before 34 weeks.
D) Recurrence is not dependent on persistence of a precipitating risk factor identified in the previous pregnancy.
Further Reading
RCOG Green-top Guideline No. 63. Antepartum Haemorrhage. Royal College of Obstetricians and Gynaecologists; 2011.