EMQ — Extended Matching Question · Review
Question 247
Delivery suite → Haemorrhage
Classification
Question
EEMQQuestion Header
Select the single most appropriate interpretation of the first-trimester finding.
Question Stem
A 30-year-old primigravida attends at 27 weeks following a small episode of APH. At 10 weeks she had vaginal bleeding and ultrasound demonstrated an intrauterine haematoma, which subsequently resolved. She is now normotensive, does not smoke and fetal growth is appropriate. Placental localisation is normal and there is currently no clinical evidence of abruption. She asks whether the early-pregnancy bleeding and haematoma have any relevance to placental abruption later in pregnancy.
Answer Bank
A
A resolved first-trimester intrauterine haematoma has no recognised relationship with later placental abruption
B
The association exists only if placenta praevia subsequently develops
C
Early bleeding predicts abruption only in women with chronic hypertension
D
First-trimester bleeding is relevant only to miscarriage risk
E
The association exists only if the haematoma remains visible after 24 weeks
F
Early intrauterine haematoma is protective against later abruption
G
The finding establishes that her current bleeding is definitely caused by abruption
H
First-trimester bleeding and an intrauterine haematoma are associated with an increased subsequent risk of placental abruption
Correct Answer
H. First-trimester bleeding and an intrauterine haematoma are associated with an increased subsequent risk of placental abruption
Explanation
First-trimester bleeding and the presence of an intrauterine haematoma have been associated with an increased risk of placental abruption later in pregnancy. This association is useful for risk assessment but is not diagnostic: the previous finding does not establish that a later APH episode is necessarily caused by abruption. Current diagnosis must still depend on the contemporary clinical presentation.
Option Validity
A) First-trimester bleeding and intrauterine haematoma have recognised associations with later abruption.
B) The association is not dependent on development of placenta praevia.
C) Hypertension is a separate risk factor and is not required for this association.
D) Early bleeding may have implications beyond miscarriage risk.
E) Persistence of the haematoma beyond 24 weeks is not required for the reported association.
F) An intrauterine haematoma is not protective against abruption.
G) A risk association does not establish the cause of a subsequent bleeding episode.
Further Reading
RCOG Green-top Guideline No. 63. Antepartum Haemorrhage. Royal College of Obstetricians and Gynaecologists; 2011.