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Question 180
Delivery suite → Haemorrhage
Classification
Question
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A woman at 37+3 weeks presents with a moderate APH and suspected placental abruption. Maternal observations remain stable after initial assessment. CTG initially shows a normal baseline with preserved variability but subsequently develops persistent fetal bradycardia. The cervix is 5 cm dilated and the fetal head remains high. Which change most importantly alters management from close assessment to immediate delivery?
Question Stem
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Options
A
Gestation beyond 37 weeks
B
The initial diagnosis of suspected abruption
C
Maternal haemodynamic stability
D
Cervical dilatation of 5 cm
E
Development of persistent fetal bradycardia
Explanation
APH management is dynamic and depends on current maternal and fetal condition. Suspected abruption in a stable woman with reassuring fetal status does not invariably require immediate operative delivery. The development of persistent fetal bradycardia, however, represents acute fetal compromise and creates an indication for immediate delivery. Because vaginal birth is not imminent with the fetal head high and the cervix only 5 cm dilated, emergency caesarean birth would generally be required while maternal assessment and resuscitation continue.
Option Validity
A) Term gestation influences planning but is not the decisive new indication in this scenario.
B) Suspected abruption was already present before the management threshold changed.
C) Maternal stability does not negate a new indication for delivery arising from severe fetal compromise.
D) Cervical dilatation does not itself mandate immediate delivery and vaginal birth is not yet imminent.
Further Reading
RCOG Green-top Guideline No. 63. Antepartum Haemorrhage. Royal College of Obstetricians and Gynaecologists; 2011.