EMQ — Extended Matching Question · Review
Question 234
Delivery suite → Haemorrhage
Classification
Question
EEMQQuestion Header
Select the single most appropriate plan for the remainder of the pregnancy.
Question Stem
A 31-year-old G2P1 was admitted at 29+6 weeks following an unexplained APH of approximately 150 mL. Placenta praevia was excluded, there were no clinical features of abruption and no local bleeding source was identified. Maternal observations and investigations remained reassuring, fetal assessment was normal and the bleeding stopped. She is now 31+2 weeks with no recurrence and asks whether she can return completely to routine low-risk antenatal care because no cause was found.
Answer Bank
A
Return to routine low-risk care because the bleeding has not recurred
B
Additional surveillance is indicated only if placenta praevia is subsequently diagnosed
C
A reassuring fetal assessment during admission removes subsequent pregnancy risk
D
Unexplained APH increases preterm birth risk but has no association with fetal growth
E
Unexplained APH affects fetal growth but does not alter stillbirth risk
F
Recognise unexplained APH as a marker of increased adverse pregnancy risk and arrange appropriate consultant-led surveillance including fetal growth assessment
G
Escalate surveillance only after a second episode of APH
H
Base subsequent antenatal care solely on the maternal haemoglobin concentration
Correct Answer
F. Recognise unexplained APH as a marker of increased adverse pregnancy risk and arrange appropriate consultant-led surveillance including fetal growth assessment
Explanation
An episode of unexplained APH is not rendered prognostically irrelevant simply because the bleeding resolves and initial assessment is reassuring. It is associated with increased risks including preterm delivery, stillbirth and smaller babies. Subsequent pregnancy care should therefore recognise the pregnancy as higher risk and include appropriate consultant-led surveillance and assessment of fetal growth.
Option Validity
A) Resolution without recurrence does not return the pregnancy automatically to baseline risk.
B) The adverse-risk association exists even when placenta praevia has been excluded.
C) Reassuring fetal assessment during the acute episode does not abolish later pregnancy risk.
D) Unexplained APH is also associated with smaller babies.
E) Increased stillbirth risk has also been reported.
G) A single unexplained APH episode may justify alteration of subsequent surveillance.
H) Maternal haemoglobin does not capture the subsequent fetal and obstetric risks.
Further Reading
RCOG Green-top Guideline No. 63. Antepartum Haemorrhage. Royal College of Obstetricians and Gynaecologists; 2011.