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Question 187
Delivery suite → Haemorrhage
Classification
Question
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A woman at 35 weeks presents with APH. Speculum examination identifies a cervical ectropion that bleeds on contact. However, she also reports new constant abdominal pain, the uterus is tender and CTG demonstrates recurrent decelerations. Which is the most appropriate interpretation?
Question Stem
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Options
A
The cervical finding explains the bleeding and therefore excludes placental abruption
B
The cervical finding should not prematurely close the diagnosis; the additional maternal and fetal findings require assessment and management for possible abruption
C
Abruption can be diagnosed only if ultrasound subsequently demonstrates a retroplacental clot
D
The abnormal CTG can be attributed to cervical bleeding because maternal observations are stable
E
Further obstetric assessment is unnecessary once a visible genital-tract source has been demonstrated
Explanation
Identification of one plausible source of vaginal bleeding should not produce diagnostic closure when other findings indicate a potentially more dangerous concurrent process. Cervical ectropion can cause bleeding, but it does not explain constant abdominal pain, uterine tenderness and recurrent fetal heart rate decelerations. These findings require urgent assessment for placental abruption and fetal compromise. Because abruption is principally a clinical diagnosis and ultrasound has poor sensitivity, management should not depend on demonstration of a retroplacental clot.
Option Validity
A) A cervical source does not exclude simultaneous placental pathology.
C) Ultrasound confirmation is not required for a clinical diagnosis of abruption.
D) Recurrent fetal decelerations cannot appropriately be attributed to cervical ectropion.
E) Significant additional maternal and fetal abnormalities mandate continued obstetric assessment despite a visible cervical lesion.
Further Reading
RCOG Green-top Guideline No. 63. Antepartum Haemorrhage. Royal College of Obstetricians and Gynaecologists; 2011.