EMQ

EMQ — Extended Matching Question · Review

Question 240

Delivery suite → Haemorrhage

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Type EEMQ

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Classification

Speciality

Obstetrics and Gynaecology

Group

Clinical

Title

Delivery suite

Topic

Haemorrhage

Subtopic 1

Antepartum haemorrhage

Subtopic 2

Placenta praevia

Subtopic 3

Management

Question Type

EMQ

Question

EEMQ

Question Header

Question Stem

A 35-year-old G3P2 at 31+4 weeks has placenta praevia confirmed on ultrasound. She was admitted after a painless APH that has completely settled. Maternal observations are normal, haemoglobin is stable and fetal assessment is reassuring. She is not contracting. During the ward round, several strategies are proposed specifically to reduce the likelihood of another haemorrhage or prolong pregnancy, including routine prophylactic tocolysis, cervical cerclage and restriction of penetrative intercourse. The team reviews which approach is supported by the guideline.

Answer Bank

A Start routine prophylactic tocolysis until 37 weeks

B Insert cervical cerclage routinely to prevent recurrent bleeding

C Encourage penetrative intercourse because it has no relationship to bleeding risk

D Use prophylactic tocolysis and cerclage together

E Avoid penetrative sexual intercourse; routine prophylactic tocolysis is not recommended and cerclage should not be used outside a clinical trial

F Cerclage is established standard care whenever placenta praevia bleeds before 34 weeks

G Long-term tocolysis is indicated even in the absence of uterine activity

H No counselling regarding sexual intercourse is required

Correct Answer

E. Avoid penetrative sexual intercourse; routine prophylactic tocolysis is not recommended and cerclage should not be used outside a clinical trial

Explanation

For placenta praevia, women should be advised to avoid penetrative sexual intercourse because it may precipitate bleeding. Routine prophylactic tocolysis is not recommended in the absence of an appropriate clinical indication, and evidence is insufficient to support cervical cerclage as routine management; cerclage should not be used for this purpose outside a clinical trial. The question requires distinguishing several proposed interventions that may appear intuitively capable of prolonging pregnancy but lack appropriate evidence.

Option Validity

A) Routine prophylactic tocolysis is not recommended simply because placenta praevia is present.

B) Evidence does not support routine cervical cerclage for placenta praevia.

C) Penetrative intercourse may precipitate bleeding and avoidance should be advised.

D) Combining two unsupported prophylactic interventions does not make them appropriate.

F) Cerclage is not established standard management for bleeding placenta praevia.

G) Long-term tocolysis is not routinely indicated in an asymptomatic woman without uterine activity.

H) Counselling about avoidance of penetrative intercourse is relevant.

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Updated

2026-10-06 01:57:35

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