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Question 155
Delivery suite → Haemorrhage
Classification
Question
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A woman at 35 weeks presents with recurrent small-volume APH. Placental location is normal. She has no abdominal pain, uterine tenderness or contractions, and fetal assessment is reassuring. Speculum examination demonstrates an abnormal friable cervical lesion that bleeds on contact. Which interpretation is most appropriate?
Question Stem
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Options
A
A local genital-tract cause has been demonstrated, but maternal and fetal assessment of the APH remains necessary
B
The cervical lesion proves that placental abruption cannot coexist
C
The lesion should be ignored because cervical abnormalities cannot cause APH
D
Digital vaginal examination is now mandatory to exclude concealed placental bleeding
E
Identification of a cervical source makes fetal assessment unnecessary
Explanation
APH may arise from causes other than placenta praevia or placental abruption, including cervical and vaginal pathology. Speculum examination can therefore be diagnostically useful and may identify a local source of bleeding. However, identifying such a lesion does not justify abandoning appropriate maternal and fetal assessment, particularly when the woman has recurrent APH. Clinical assessment must integrate the apparent source, severity of bleeding, maternal condition and fetal wellbeing rather than treating one examination finding as absolute proof that no additional obstetric pathology exists.
Option Validity
B) Identification of a cervical source of bleeding does not prove that a separate obstetric pathology cannot coexist.
C) Cervical and vaginal pathology are recognised non-placental causes of antepartum haemorrhage.
D) Digital vaginal examination is not a diagnostic test for concealed placental haemorrhage and remains subject to appropriate precautions regarding placental location.
E) Appropriate fetal assessment remains part of the evaluation of antepartum haemorrhage despite identification of an apparent local source.
Further Reading
RCOG Green-top Guideline No. 63. Antepartum Haemorrhage. Royal College of Obstetricians and Gynaecologists; 2011.