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Question 189
Delivery suite → Haemorrhage
Classification
Question
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A woman at 31+5 weeks is admitted following preterm rupture of membranes. Forty-eight hours later she develops vaginal bleeding. Which new feature would most substantially increase concern that the bleeding represents placental abruption rather than uncomplicated bleeding associated with cervical change?
Question Stem
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Options
A
Absence of maternal pyrexia
B
Cervix remaining less than 2 cm dilated
C
Constant abdominal pain with new uterine tenderness
D
Clear liquor continuing to drain
E
Fetal presentation remaining cephalic
Explanation
Preterm rupture of membranes is itself associated with increased risk of placental abruption. When APH subsequently develops, new constant abdominal pain and uterine tenderness materially strengthen the clinical suspicion of abruption. This requires integration of the pre-existing risk state with the new clinical phenotype rather than attributing bleeding automatically to cervical change. Abruption remains principally a clinical diagnosis, and management should respond to maternal and fetal condition.
Option Validity
A) Absence of maternal pyrexia does not meaningfully reduce the clinical significance of pain and uterine tenderness in this context.
B) Cervical dilatation does not discriminate reliably between placental abruption and another source of APH.
D) Continued liquor drainage does not explain the new painful haemorrhage or exclude abruption.
E) Cephalic presentation does not meaningfully reduce suspicion of abruption.
Further Reading
RCOG Green-top Guideline No. 63. Antepartum Haemorrhage. Royal College of Obstetricians and Gynaecologists; 2011.