EMQ

EMQ — Extended Matching Question · Review

Question 239

Delivery suite → Haemorrhage

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Classification

Speciality

Obstetrics and Gynaecology

Group

Clinical

Title

Delivery suite

Topic

Haemorrhage

Subtopic 1

Antepartum haemorrhage

Subtopic 2

Placental abruption

Subtopic 3

Prevention

Question Type

EMQ

Question

EEMQ

Question Header

Question Stem

A 29-year-old woman is seen before conception after a previous pregnancy complicated by severe placental abruption. During thrombophilia testing performed elsewhere, a thrombophilic tendency was reported. She has read online that daily anticoagulant injections throughout pregnancy will prevent another abruption and asks for treatment before trying to conceive. She has no personal history of venous thromboembolism. The consultation focuses specifically on whether antithrombotic treatment can be recommended solely to prevent recurrent placental abruption.

Answer Bank

A Therapeutic-dose anticoagulation is proven to prevent recurrent abruption and should routinely be started before conception

B Aspirin and heparin together eliminate the recurrence risk

C Antithrombotic therapy is mandatory whenever any thrombophilia is identified

D There is insufficient evidence to recommend antithrombotic therapy specifically for prevention of placental abruption on this basis

E Anticoagulation should be prescribed because previous abruption is itself equivalent to venous thromboembolism

F Enoxaparin has definitive evidence of preventing recurrent abruption in all affected women

G No modifiable or associated risk factors should be addressed because abruption cannot be influenced

H Anticoagulation should be based solely on the gestation at which the previous abruption occurred

Correct Answer

D. There is insufficient evidence to recommend antithrombotic therapy specifically for prevention of placental abruption on this basis

Explanation

Although thrombophilic disorders have been investigated in relation to placental abruption, evidence is insufficient to recommend antithrombotic therapy specifically as a proven strategy for preventing abruption. Preliminary evidence involving enoxaparin does not establish routine preventive treatment. Any indication for thromboprophylaxis should therefore be assessed on its own merits rather than assuming that previous abruption alone establishes an evidence-based indication.

Option Validity

A) Routine therapeutic anticoagulation has not been proven to prevent recurrent placental abruption.

B) Combined treatment cannot be said to eliminate recurrence risk.

C) Identification of a thrombophilic tendency does not automatically establish an indication for treatment specifically to prevent abruption.

E) Previous placental abruption is not equivalent to a previous venous thromboembolic event.

F) Preliminary study data do not constitute definitive evidence for universal enoxaparin prophylaxis.

G) Relevant modifiable risk factors should still be addressed even though a specific pharmacological preventive strategy is not established.

H) Gestation of the previous event alone does not establish an indication for anticoagulation.

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Updated

2026-10-06 01:57:35

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