EMQ

EMQ — Extended Matching Question · Review

Question 275

Delivery suite → Haemorrhage

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Type EEMQ

UUID 67262410-faaf-4be4-9861-33f8b97b6d40

Classification

Speciality

Obstetrics and Gynaecology

Group

Clinical

Title

Delivery suite

Topic

Haemorrhage

Subtopic 1

Antepartum haemorrhage

Subtopic 2

Placenta praevia

Subtopic 3

Tocolysis after APH

Question Type

EMQ

Question

EEMQ

Question Header

Question Stem

A 30-year-old G2P1 with confirmed placenta praevia is admitted at 30+6 weeks after her second painless APH. Bleeding has now stopped. Maternal observations are normal and fetal assessment is reassuring. She has occasional irregular uterine tightenings without progressive cervical change. A plan is proposed for routine prophylactic nifedipine throughout the admission specifically to prevent further bleeding and prolong the pregnancy, despite the absence of established preterm labour.

Answer Bank

A Start routine prophylactic tocolysis because it prevents recurrent haemorrhage

B Continue tocolysis until 37 weeks in every woman with placenta praevia

C Use tocolysis because it eliminates the need for subsequent fetal surveillance

D Do not use routine prophylactic tocolysis simply to prevent recurrent bleeding or prolong pregnancy in a stable woman with placenta praevia

E Use tocolysis whenever any uterine tightening is reported after APH

F Use tocolysis only after digital vaginal examination confirms cervical closure

G Tocolysis is mandatory after the second episode of APH

H Routine prophylactic tocolysis is indicated because maternal observations are normal

Correct Answer

D. Do not use routine prophylactic tocolysis simply to prevent recurrent bleeding or prolong pregnancy in a stable woman with placenta praevia

Explanation

Routine prophylactic tocolysis is not recommended merely to prevent recurrent haemorrhage or prolong pregnancy in women with placenta praevia. The presence of occasional non-progressive tightenings does not itself justify prolonged prophylactic treatment. Management must remain responsive to the clinical situation rather than using tocolysis as routine haemorrhage prevention.

Option Validity

A) Routine prophylactic tocolysis has not been established as a strategy to prevent recurrent APH.

B) There is no recommendation for universal continuation of tocolysis until 37 weeks.

C) Tocolysis does not replace appropriate maternal and fetal surveillance.

E) Irregular tightenings without established preterm labour do not automatically justify routine prophylactic treatment.

F) Digital vaginal examination is not required to justify withholding prophylactic tocolysis and may be hazardous with placenta praevia.

G) Number of APH episodes alone does not create a mandatory indication for tocolysis.

H) Maternal stability does not create an indication for routine prophylactic tocolysis.

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Updated

2026-10-06 01:57:35

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