SBA — Single Best Answer · Review
Question 199
Delivery suite → Haemorrhage
Classification
Question
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A woman at 35 weeks presents with new APH and abdominal pain. Her pregnancy has been complicated by severe fetal growth restriction. Maternal observations are currently normal and ultrasound shows no retroplacental collection. Which interpretation best integrates the fetal growth history into the current assessment?
Question Stem
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Options
A
Growth restriction makes placental abruption less likely because the placenta is smaller
B
Growth restriction is a recognised association with placental abruption and should increase clinical suspicion when compatible symptoms develop
C
Growth restriction confirms that placental abruption has already occurred
D
A normal ultrasound overrides the increased pre-test probability associated with growth restriction
E
Growth restriction is relevant only after an abruption has been diagnosed
Explanation
Fetal growth restriction is associated with placental abruption and reflects a pregnancy already affected by placental dysfunction. In a woman who subsequently develops APH and abdominal pain, that background should increase the pre-test probability of abruption. However, it remains a risk factor rather than a diagnostic test. The current diagnosis must still be made clinically, and a normal ultrasound cannot reliably exclude abruption because sensitivity for retroplacental haemorrhage is poor.
Option Validity
A) Fetal growth restriction is associated with, rather than protective against, placental abruption.
C) An epidemiological association does not establish that abruption has occurred.
D) A negative ultrasound cannot reliably exclude abruption and should not override a concerning clinical presentation.
E) Growth restriction is relevant to pre-test risk before the diagnosis is established.
Further Reading
RCOG Green-top Guideline No. 63. Antepartum Haemorrhage. Royal College of Obstetricians and Gynaecologists; 2011.