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Question 200
Delivery suite → Haemorrhage
Classification
Question
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A 39-year-old woman presents with painless APH at 31 weeks. She has no previous caesarean birth or termination of pregnancy. Her history includes chronic endometritis after a previous delivery and hysteroscopic treatment of a submucous fibroid. Which interpretation is most appropriate?
Question Stem
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Options
A
Absence of previous caesarean birth makes placenta praevia unlikely enough to omit assessment of placental location
B
Endometrial damage from previous uterine pathology or instrumentation is relevant because deficient endometrium is associated with placenta praevia
C
Submucous fibroids reduce the risk of low placental implantation
D
Chronic endometritis is relevant only to preterm labour and not placental location
E
Previous uterine pathology matters only when it resulted in a classical caesarean scar
Explanation
Placenta praevia is associated not only with previous caesarean birth but also with conditions producing deficient or damaged endometrium. Relevant associations include endometritis, curettage, manual removal of the placenta and submucous fibroids. Therefore, a woman without a caesarean scar may still have a meaningful risk profile for placenta praevia. In the setting of painless APH, placental location should be established rather than relying on the absence of the most familiar scar-related risk factor.
Option Validity
A) Placenta praevia can occur without previous caesarean birth.
C) Submucous fibroids are associated with abnormal endometrial conditions rather than protection from low implantation.
D) Previous endometrial pathology can be relevant to placental implantation.
E) Endometrial damage need not involve a caesarean scar to influence risk.
Further Reading
RCOG Green-top Guideline No. 63. Antepartum Haemorrhage. Royal College of Obstetricians and Gynaecologists; 2011.