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Question 184
Delivery suite → Haemorrhage
Classification
Question
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Two women at 32 weeks are assessed following APH. Both currently have normal observations and reassuring fetal assessment. Woman X had a single episode of spotting that stopped before assessment; placenta praevia has been excluded and no further bleeding occurs. Woman Y has had three episodes of unexplained bleeding over seven days, the most recent being 40 mL earlier today. Which distinction most appropriately influences disposition?
Question Stem
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Options
A
Both must remain admitted until delivery because any APH before 34 weeks prohibits discharge
B
Woman X must remain admitted because spotting carries greater concealed-haemorrhage risk than recurrent bleeding
C
Both should automatically be discharged because their current observations are normal
D
Woman Y may require continued admission or more cautious individualised management because recurrence changes the risk context despite current stability
E
Woman Y can be discharged preferentially because each individual bleed remains below 50 mL
Explanation
Current haemodynamic and fetal stability are important but are not the only determinants of disposition after APH. A woman with a single episode of resolved spotting, reassuring assessment and excluded placenta praevia may be suitable for discharge. Recurrent unexplained APH represents a different clinical risk context and requires individualised consideration of recurrence, gestation, access to hospital and maternal-fetal surveillance. The numerical volume of the latest episode should not be interpreted in isolation.
Option Validity
A) There is no universal requirement for admission until delivery after every episode of APH before 34 weeks.
B) Recurrent bleeding generally warrants greater caution than a single completely resolved episode of spotting.
C) Normal observations at one time point do not erase the significance of recurrent APH.
E) Repeated episodes cannot be reduced to the volume classification of the latest bleed alone.
Further Reading
RCOG Green-top Guideline No. 63. Antepartum Haemorrhage. Royal College of Obstetricians and Gynaecologists; 2011.