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Question 188
Delivery suite → Haemorrhage
Classification
Question
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A nulliparous woman at 30 weeks is found to have a low-lying placenta after presenting with painless APH. She has never had a caesarean birth and asks why she might nevertheless have developed abnormal placental implantation. Which previous history provides the most relevant alternative mechanism recognised in the APH guideline?
Question Stem
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Options
A
Previous curettage of the uterine cavity following miscarriage
B
Previous cervical punch biopsy
C
Previous laparoscopic ovarian cystectomy
D
Previous treatment for vulvovaginal candidiasis
E
Previous uncomplicated diagnostic laparoscopy
Explanation
Placenta praevia is not restricted to women with previous caesarean birth. Conditions or procedures associated with deficient or damaged endometrium are recognised risk factors, including previous curettage and other uterine instrumentation. The reasoning is therefore to identify a history capable of altering the endometrial environment in which implantation occurs rather than simply looking for previous abdominal or gynaecological surgery. The other procedures listed do not produce the same endometrial injury.
Option Validity
B) A cervical biopsy does not produce endometrial damage associated with placenta praevia.
C) Ovarian surgery does not directly damage the uterine endometrium.
D) Treatment of candidiasis is unrelated to placental implantation.
E) Uncomplicated diagnostic laparoscopy does not itself produce the endometrial injury relevant to placenta praevia.
Further Reading
RCOG Green-top Guideline No. 63. Antepartum Haemorrhage. Royal College of Obstetricians and Gynaecologists; 2011.