EMQ

EMQ — Extended Matching Question · Review

Question 276

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

Placenta praevia

Subtopic 3

Cervical cerclage

Question Type

EMQ

Question

EEMQ

Question Header

Question Stem

A 36-year-old G3P2 with placenta praevia has had two admissions for painless APH by 29+5 weeks. She is currently stable, the bleeding has stopped and fetal assessment is reassuring. Cervical length is not significantly shortened and there is no established cervical insufficiency. During multidisciplinary discussion, prophylactic cervical cerclage is proposed specifically as a strategy to reduce further haemorrhage and prolong the pregnancy because recurrent bleeding has already occurred.

Answer Bank

A Cerclage is standard treatment after the second APH with placenta praevia

B Cerclage should be performed whenever bleeding occurs before 32 weeks

C Cerclage is indicated because a normal cervical length predicts benefit

D Cerclage should replace subsequent inpatient assessment

E Cerclage is recommended whenever placenta praevia is associated with a viable fetus

F Cerclage should be performed before any further ultrasound

G Cerclage is mandatory if tocolysis is not being used

H Evidence is insufficient to support cervical cerclage for placenta praevia outside a clinical trial

Correct Answer

H. Evidence is insufficient to support cervical cerclage for placenta praevia outside a clinical trial

Explanation

The available evidence is insufficient to recommend cervical cerclage as routine management for placenta praevia with the aim of preventing recurrent bleeding or prolonging pregnancy. Its use for this indication should therefore be confined to a clinical trial rather than introduced simply because APH has recurred. The scenario deliberately distinguishes recurrent bleeding from a conventional cervical-insufficiency indication.

Option Validity

A) Recurrent APH does not establish cerclage as standard therapy for placenta praevia.

B) Gestation below 32 weeks with bleeding does not itself create an indication for cerclage.

C) A normal cervical length does not establish benefit from cerclage for placenta praevia.

D) Cerclage does not replace appropriate assessment and surveillance.

E) Fetal viability does not create an indication for cerclage in placenta praevia.

F) Cerclage should not be inserted as an automatic step before further imaging or assessment.

G) Absence of tocolysis does not create a mandatory indication for cerclage.

Source & metrics

Authored Difficulty

5.00

Evaluation Score

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Destination

eBook

Source

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Source Section

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Source Locator

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Updated

2026-10-06 01:57:35

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