EMQ — Extended Matching Question · Review
Question 269
Delivery suite → Haemorrhage
Classification
Question
EEMQQuestion Header
Select the single most appropriate interpretation of her operative obstetric history.
Question Stem
A 40-year-old G6P4 attends following a painless APH at 28+6 weeks. She has had three previous caesarean births and one surgical uterine evacuation. The current pregnancy followed assisted conception. Ultrasound confirms a low-lying placenta requiring further localisation. A trainee suggests that previous caesarean birth is relevant only to abnormal placental adherence and has no importance when assessing the likelihood of placenta praevia itself.
Answer Bank
A
Previous caesarean birth has no association with placenta praevia
B
Caesarean history matters only after five previous operations
C
Previous caesarean birth predicts placental abruption rather than praevia
D
Caesarean history becomes relevant only after APH exceeds 500 mL
E
Previous uterine surgery is relevant only when the placenta is posterior
F
Previous caesarean birth is a recognised risk factor for placenta praevia and is clinically relevant alongside her other implantation-related risks
G
Assisted conception eliminates the relevance of previous caesarean birth
H
Maternal age is the only recognised risk factor in this history
Correct Answer
F. Previous caesarean birth is a recognised risk factor for placenta praevia and is clinically relevant alongside her other implantation-related risks
Explanation
Previous caesarean birth is a recognised risk factor for placenta praevia. This woman has several additional recognised associations, including advanced maternal age, multiparity, previous uterine instrumentation and assisted conception. Her operative history is therefore directly relevant to the probability of placenta praevia and should not be restricted conceptually to abnormal placental adherence.
Option Validity
A) Previous caesarean birth is a recognised risk factor for placenta praevia.
B) The association is not confined to women with five or more previous operations.
C) Caesarean birth is directly relevant to placenta praevia risk.
D) Risk assessment is relevant independently of the volume of a subsequent haemorrhage.
E) The association is not restricted to posterior placentation.
G) Assisted conception adds another risk association rather than cancelling the relevance of caesarean history.
H) Maternal age is one of several relevant factors in this patient.
Further Reading
RCOG Green-top Guideline No. 63. Antepartum Haemorrhage. Royal College of Obstetricians and Gynaecologists; 2011.