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Question 198
Delivery suite → Haemorrhage
Classification
Question
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A multiparous woman at 28 weeks presents with painless APH. She has never had a caesarean birth, but her previous pregnancy was complicated by placenta praevia that resolved sufficiently to allow vaginal delivery. Which aspect of her history should carry the greatest weight when assessing the likelihood of recurrent placenta praevia?
Question Stem
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Options
A
The previous placenta praevia itself
B
Previous vaginal delivery
C
Absence of uterine scar
D
Multiparity alone
E
Previous spontaneous onset of labour
Explanation
Previous placenta praevia is an important risk factor for recurrence. The fact that the previous pregnancy ultimately ended vaginally or that the woman has no caesarean scar does not erase that prior placental history. This question distinguishes recurrence risk from scar-related risk: previous caesarean birth is one important risk factor, but prior placenta praevia independently increases the likelihood of placenta praevia in a subsequent pregnancy. In a woman presenting with painless APH, placental location therefore remains a key diagnostic priority.
Option Validity
B) Previous vaginal delivery does not neutralise the recurrence risk associated with previous placenta praevia.
C) Absence of a uterine scar reduces one risk factor but does not remove the significance of previous placenta praevia.
D) Multiparity is associated with placenta praevia but is less specific than a prior history of the condition.
E) Previous spontaneous labour does not materially determine recurrence risk.
Further Reading
RCOG Green-top Guideline No. 63. Antepartum Haemorrhage. Royal College of Obstetricians and Gynaecologists; 2011.