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Question 181
Delivery suite → Haemorrhage
Classification
Question
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A woman who experienced a significant unexplained APH at 35 weeks subsequently enters spontaneous labour at 39 weeks. Labour is uncomplicated and there is no active bleeding. Which aspect of her previous APH should still directly alter management at birth?
Question Stem
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Options
A
Avoid uterotonics because previous APH increases placental sensitivity
B
Use active management of the third stage because APH is associated with increased postpartum haemorrhage risk
C
Perform manual removal of the placenta routinely
D
Give prophylactic fresh frozen plasma before placental delivery
E
Perform caesarean birth to prevent postpartum haemorrhage
Explanation
The consequences of APH extend beyond the acute bleeding episode. Women who have experienced APH have an increased risk of postpartum haemorrhage, so active management of the third stage is appropriate even when labour itself has been uncomplicated and there is no current bleeding. The previous APH does not justify routine manual placental removal, prophylactic plasma transfusion or caesarean birth. This tests recognition of a downstream management implication rather than treatment of the acute APH itself.
Option Validity
A) Active third-stage management includes appropriate uterotonic therapy rather than avoidance of uterotonics.
C) Previous APH does not justify routine manual removal of a normally delivering placenta.
D) Prophylactic plasma is not indicated without haemorrhage or a relevant coagulation abnormality.
E) Previous APH alone is not an indication for caesarean birth to prevent PPH.
Further Reading
RCOG Green-top Guideline No. 63. Antepartum Haemorrhage. Royal College of Obstetricians and Gynaecologists; 2011.