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Question 179
Delivery suite → Haemorrhage
Classification
Question
SSBAQuestion Header
Four pregnant women are counselled regarding placental abruption. Which history should carry the greatest weight when estimating recurrence risk?
Question Stem
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Options
A
Previous pregnancy complicated by placental abruption
B
Current pregnancy conceived by assisted reproduction
C
Maternal age 41 years with no previous placental disease
D
Multiparity with a non-vertex fetus
E
Cigarette smoking without previous placental abruption
Explanation
Placental abruption has multiple recognised associations, but previous placental abruption is among the strongest predictors of recurrence. This distinction matters when interpreting lists of risk factors: the presence of several weaker associations should not automatically be assumed to confer greater risk than a strong previous obstetric history. Nevertheless, even recognised risk factors have limited predictive performance, and many abruptions occur in pregnancies previously considered low risk.
Option Validity
B) Assisted reproduction is associated with placental complications but is not as strong a recurrence predictor as previous abruption.
C) Advanced maternal age is a recognised association but is less important than a previous abruption.
D) Multiparity and non-vertex presentation are associated factors but do not outweigh the recurrence significance of previous abruption.
E) Smoking is a modifiable risk factor but previous abruption is a stronger individual predictor.
Further Reading
RCOG Green-top Guideline No. 63. Antepartum Haemorrhage. Royal College of Obstetricians and Gynaecologists; 2011.