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Question 160
Delivery suite → Haemorrhage
Classification
Question
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A woman at 33+4 weeks has her second episode of unexplained APH in 10 days. Each episode has been approximately 40 mL. The current bleeding has stopped, maternal observations are normal, CTG is reassuring and placenta praevia has been excluded. She asks to be discharged immediately because each individual episode meets the volume definition of minor haemorrhage. Which factor most strongly argues against basing discharge solely on the volume of the current episode?
Question Stem
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Options
A
Any APH before 34 weeks requires admission until delivery
B
A normal CTG cannot be used in the assessment of APH
C
Minor haemorrhage automatically becomes massive when it recurs
D
Recurrent APH represents a different risk context from a single resolved episode and requires individualised assessment
E
Placenta praevia cannot be excluded by ultrasound
Explanation
Classification by measured blood volume describes the severity of an individual bleeding episode but does not capture the entire subsequent obstetric risk. Recurrent APH—more than one episode—requires individualised assessment and should not be treated automatically as equivalent to a single episode of resolved spotting. Decisions about admission and discharge should integrate recurrence, underlying cause, gestation, maternal condition, fetal wellbeing and the practical circumstances of returning rapidly to hospital if bleeding recurs.
Option Validity
A) There is no universal requirement that every woman experiencing antepartum haemorrhage before 34 weeks remain admitted until delivery.
B) Cardiotocography is an important component of fetal assessment where appropriate in antepartum haemorrhage.
C) Recurrence does not convert a minor-volume bleeding episode into massive haemorrhage by definition.
E) Ultrasound is useful for establishing placental location and excluding placenta praevia as of bleeding.
Further Reading
RCOG Green-top Guideline No. 63. Antepartum Haemorrhage. Royal College of Obstetricians and Gynaecologists; 2011.