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Question 177
Delivery suite → Haemorrhage
Classification
Question
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A woman has an unexplained APH at 30 weeks. At presentation fetal growth is appropriate and Doppler assessment is reassuring. No further bleeding occurs. Which reasoning best supports continued growth surveillance rather than returning permanently to routine low-risk care?
Question Stem
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Options
A
APH itself proves that fetal growth restriction is already present
B
A normal growth assessment at 30 weeks excludes subsequent placental dysfunction
C
Unexplained APH is associated with later adverse outcomes including impaired fetal growth, so a reassuring initial assessment does not eliminate subsequent risk
D
Serial growth scans are required solely because ultrasound cannot diagnose abruption
E
All women with APH will ultimately require preterm delivery
Explanation
A reassuring fetal assessment at the time of APH answers the question of current fetal condition; it does not eliminate subsequent risk. Unexplained APH is associated with adverse pregnancy outcomes, including fetal growth restriction and preterm birth, consistent with an underlying placental dysfunction phenotype in some pregnancies. Serial growth surveillance therefore addresses a future risk that cannot be excluded by a single normal assessment.
Option Validity
A) APH increases subsequent risk but does not itself establish existing fetal growth restriction.
B) Normal growth at one gestation cannot exclude later growth impairment.
D) The rationale for serial growth surveillance is the subsequent risk of adverse fetal growth, not merely ultrasound's limitations in diagnosing abruption.
E) APH increases the risk of preterm delivery but does not make it inevitable.
Further Reading
RCOG Green-top Guideline No. 63. Antepartum Haemorrhage. Royal College of Obstetricians and Gynaecologists; 2011.