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Question 202
Delivery suite → Haemorrhage
Classification
Question
SSBAQuestion Header
A woman at 36 weeks with a transverse lie presents with sudden APH and abdominal pain. Maternal observations are currently stable and CTG is reassuring. Which interpretation of the fetal presentation is most appropriate?
Question Stem
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Options
A
Transverse lie excludes abruption because placental separation requires cephalic engagement
B
Non-vertex presentation is a recognised association with placental abruption and should contribute to the overall clinical suspicion
C
Fetal presentation is irrelevant once bleeding has begun
D
Transverse lie confirms placenta praevia rather than abruption
E
Non-vertex presentation is relevant only after fetal compromise develops
Explanation
Non-vertex presentation is among the recognised associations with placental abruption. It does not establish the diagnosis, but in a woman with APH and abdominal pain it increases the pre-test probability and should be integrated into the overall clinical assessment. This is distinct from using a risk factor as proof: maternal condition, uterine findings, bleeding characteristics and fetal status still determine the working diagnosis and urgency of management.
Option Validity
A) Placental abruption is not dependent on cephalic engagement.
C) Fetal presentation remains relevant as part of the risk context.
D) Transverse lie does not confirm placenta praevia.
E) The association is relevant before fetal compromise develops.
Further Reading
RCOG Green-top Guideline No. 63. Antepartum Haemorrhage. Royal College of Obstetricians and Gynaecologists; 2011.