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Question 205
Delivery suite → Haemorrhage
Classification
Question
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A nulliparous woman at 29 weeks presents with painless APH. She has no previous caesarean birth but has undergone two surgical uterine evacuations for previous miscarriages. Which interpretation is most appropriate?
Question Stem
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Options
A
Nulliparity excludes placenta praevia as a meaningful possibility
B
Previous uterine evacuation is irrelevant because only caesarean scars alter placental implantation
C
Repeated uterine instrumentation may contribute to endometrial damage and therefore remains relevant to placenta praevia risk
D
Previous miscarriage reduces the risk of placenta praevia
E
Placenta praevia should be considered only if she has had a previous manual removal of placenta
Explanation
Placenta praevia is associated with several forms of previous endometrial injury, not just caesarean scarring. Repeated uterine evacuation or curettage may contribute to a deficient endometrial environment and therefore remains relevant to abnormal placental implantation. In a nulliparous woman with painless APH, this history should prevent false reassurance based on the absence of a previous caesarean birth.
Option Validity
A) Placenta praevia can occur in nulliparous women.
B) Previous uterine instrumentation can be relevant to endometrial damage and placental implantation.
D) Previous miscarriage does not provide protection against placenta praevia.
E) Manual removal is one example of uterine/endometrial injury but is not the only relevant history.
Further Reading
RCOG Green-top Guideline No. 63. Antepartum Haemorrhage. Royal College of Obstetricians and Gynaecologists; 2011.