EMQ

EMQ — Extended Matching Question · Review

Question 277

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

Placental abruption

Subtopic 3

Antithrombotic prevention

Question Type

EMQ

Question

EEMQ

Question Header

Question Stem

A 35-year-old G4P1 is reviewed preconceptually after a previous pregnancy ended in emergency delivery at 33 weeks for severe placental abruption. Subsequent investigation identified a thrombophilic tendency. She has read about low-molecular-weight heparin and asks whether antithrombotic therapy should routinely be prescribed in her next pregnancy specifically to prevent another abruption. She has no separate current indication for therapeutic anticoagulation. The clinician reviews the evidence available in the APH guideline.

Answer Bank

A Therapeutic-dose heparin is mandatory after any previous placental abruption

B Evidence is insufficient to recommend routine antithrombotic therapy specifically for prevention of recurrent placental abruption, despite preliminary evidence in selected populations

C Aspirin and heparin together completely prevent recurrent abruption

D Antithrombotic treatment is indicated whenever a previous abruption occurred before 37 weeks

E Low-molecular-weight heparin is recommended solely because thrombophilia and abruption have been associated

F Antithrombotic therapy is contraindicated in every subsequent pregnancy after abruption

G Anticoagulation should be started only after an APH occurs

H Previous abruption has no recurrence risk and therefore no preventive counselling is required

Correct Answer

B. Evidence is insufficient to recommend routine antithrombotic therapy specifically for prevention of recurrent placental abruption, despite preliminary evidence in selected populations

Explanation

Although thrombophilic disorders have been associated with placental abruption and preliminary studies have explored low-molecular-weight heparin, the evidence is insufficient to support routine antithrombotic treatment specifically to prevent recurrent abruption. This does not preclude anticoagulation for a separate established maternal indication. The distinction is between biological plausibility or preliminary evidence and a sufficiently supported routine preventive recommendation.

Option Validity

A) Previous abruption alone does not mandate therapeutic-dose heparin.

C) Available evidence does not establish complete prevention with combined antithrombotic therapy.

D) Preterm occurrence of a previous abruption does not itself create a routine anticoagulation indication.

E) Association between thrombophilia and abruption does not by itself prove benefit from routine preventive anticoagulation.

F) Antithrombotic therapy is not universally contraindicated; it may be indicated for separate recognised reasons.

G) Preventive anticoagulation is not defined as treatment commenced only after APH develops.

H) Previous abruption is an important recurrence risk and warrants appropriate counselling.

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Updated

2026-10-06 01:57:35

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