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Question 201
Delivery suite → Haemorrhage
Classification
Question
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A woman with a previous placental abruption is planning another pregnancy. She smokes 15 cigarettes daily, intermittently uses cocaine and has no hypertension or thrombophilia. She asks which intervention has the clearest rationale for reducing modifiable abruption risk before conception.
Question Stem
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Options
A
Routine LMWH throughout pregnancy irrespective of thrombosis risk
B
Serial ultrasound from conception to detect abruption before symptoms
C
Elective caesarean birth at 34 weeks in every future pregnancy
D
Smoking cessation and complete avoidance of cocaine
E
Routine prophylactic transfusion of plasma during the third trimester
Explanation
Prevention of placental abruption is limited because prediction is imperfect and many risk factors are non-modifiable. However, cigarette smoking and cocaine use are recognised modifiable risk factors. Pre-pregnancy counselling should therefore prioritise smoking cessation and avoidance of cocaine or other relevant substance misuse. There is no evidence supporting routine anticoagulation, serial ultrasound screening for abruption, prophylactic preterm caesarean birth or blood-component therapy as generic preventive strategies in an otherwise stable woman.
Option Validity
A) Routine LMWH is not established as a universal preventive treatment for recurrent abruption.
B) Ultrasound cannot reliably predict or screen for future abruption.
C) Previous abruption does not mandate routine very-preterm caesarean birth in all subsequent pregnancies.
E) Plasma transfusion has no preventive role in a woman without active haemorrhage or coagulopathy.
Further Reading
RCOG Green-top Guideline No. 63. Antepartum Haemorrhage. Royal College of Obstetricians and Gynaecologists; 2011.