Question 206

Placental abruption is primarily a clinical diagnosis. Sudden abdominal pain, uterine tenderness or hypertonicity and fetal compromise strongly support abruption even when ultrasound does not demonstrate a retroplacental collection. A negative ultrasound cannot reliably exclude abruption.

B) Placenta praevia classically causes painless bleeding and does not explain the tender hypertonic uterus.

C) Vasa praevia is particularly suspected when bleeding follows rupture of membranes with rapid fetal compromise.

D) Cervical ectropion does not explain severe abdominal pain, uterine hypertonicity and fetal compromise.

E) Cervical malignancy may cause APH but does not fit this acute painful uterine presentation.

F) A show is associated with labour and does not explain this constellation of maternal and fetal findings.

G) Vaginal trauma would require an appropriate local history or examination finding and does not explain uterine hypertonicity.

H) The haemorrhage should not be labelled unexplained when the clinical findings strongly support placental abruption.

RCOG Green-top Guideline No. 63. Antepartum Haemorrhage. Royal College of Obstetricians and Gynaecologists; 2011.