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Question 194
Delivery suite → Haemorrhage
Classification
Question
SSBAQuestion Header
A woman at 37 weeks experiences spontaneous rupture of membranes followed immediately by fresh vaginal bleeding. She remains haemodynamically stable, but the fetal heart rate rapidly deteriorates. The uterus is soft and non-tender. Which diagnosis should be specifically considered because of the temporal relationship between bleeding and membrane rupture?
Question Stem
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Options
A
Placental abruption
B
Vasa praevia with rupture of fetal vessels
C
Cervical ectropion
D
Maternal coagulopathy
E
Unexplained APH
Explanation
The timing is the key discriminator. Bleeding from ruptured vasa praevia should be considered when APH is associated with spontaneous or iatrogenic rupture of the fetal membranes. Severe fetal deterioration may occur despite relatively preserved maternal observations because the blood loss may be fetal rather than maternal. A soft, non-tender uterus also makes significant abruption less characteristic. The question therefore requires identifying a different haemorrhage mechanism rather than treating every APH with fetal compromise as placental abruption.
Option Validity
A) Abruption remains a differential diagnosis, but immediate bleeding after membrane rupture with severe fetal deterioration specifically raises vasa praevia.
C) Cervical ectropion does not explain the characteristic temporal relationship and acute fetal compromise.
D) Maternal coagulopathy would not specifically explain bleeding beginning immediately after membrane rupture with disproportionate fetal deterioration.
E) A specific high-risk diagnosis should be considered before labelling the episode unexplained.
Further Reading
RCOG Green-top Guideline No. 63. Antepartum Haemorrhage. Royal College of Obstetricians and Gynaecologists; 2011.