SBA — Single Best Answer · Review
Question 204
Delivery suite → Haemorrhage
Classification
Question
SSBAQuestion Header
A woman at 30 weeks with preterm prelabour rupture of membranes develops pyrexia, uterine tenderness and a small APH. Which reasoning is most appropriate?
Question Stem
—
Options
A
Infection and membrane rupture are recognised associations with abruption, so the combination should heighten concern for placental separation rather than assuming isolated infection
B
Pyrexia makes abruption impossible because abruption is non-inflammatory
C
Vaginal bleeding in the presence of infection is always cervical in origin
D
Abruption should be considered only if visible blood loss exceeds 500 mL
E
Infection is relevant only to postpartum haemorrhage
Explanation
Infection and rupture of membranes are recognised associations with placental abruption. In a woman with PPROM who subsequently develops pyrexia, uterine tenderness and APH, it would be unsafe to attribute the entire picture to infection alone. The possibility of concurrent placental separation should be considered and maternal-fetal assessment escalated accordingly. The volume of visible bleeding is not a reliable discriminator because haemorrhage may be concealed.
Option Validity
B) Infection does not exclude placental abruption.
C) Bleeding in this setting cannot automatically be attributed to the cervix.
D) Visible blood loss need not exceed a threshold before abruption becomes clinically important.
E) Infection is relevant antenatally in the risk context of abruption.
Further Reading
RCOG Green-top Guideline No. 63. Antepartum Haemorrhage. Royal College of Obstetricians and Gynaecologists; 2011.