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Question 62
Delivery suite → Haemorrhage
Classification
Question
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A woman at 33 weeks presents with sudden abdominal pain and a small antepartum haemorrhage. She is normotensive and the CTG is initially reassuring. Her booking history shows a first-trimester intrauterine haematoma associated with threatened miscarriage, which subsequently resolved completely.
Which interpretation of that early-pregnancy history is most appropriate?
Which interpretation of that early-pregnancy history is most appropriate?
Question Stem
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Options
A
Once the haematoma resolves, it has no relevance to placental abruption later in pregnancy
B
First-trimester bleeding is relevant only to miscarriage risk and not late placental complications
C
The previous intrauterine haematoma independently confirms that the current antepartum haemorrhage is an abruption
D
A previous first-trimester intrauterine haematoma increases subsequent abruption risk and should strengthen, but not establish, the current clinical suspicion
E
The early haematoma means ultrasound must demonstrate retroplacental bleeding before abruption can be diagnosed
Explanation
First-trimester bleeding is associated with an increased subsequent risk of placental abruption, and the association is stronger when an intrauterine haematoma has been identified. However, this is a risk factor rather than a diagnostic test. It increases the pre-test probability of placental abruption but does not establish the diagnosis of the current episode. The woman must therefore still undergo clinical assessment based on the characteristics of the bleeding, abdominal pain, uterine findings, maternal condition and fetal wellbeing. A previously resolved intrauterine haematoma should strengthen clinical suspicion in an appropriate presentation, but neither it nor any other isolated historical risk factor is sufficient to diagnose abruption.
Option Validity
A) Resolution of the early haematoma does not remove its recognised association with later placental abruption.
B) First-trimester bleeding is associated with an increased subsequent risk of placental abruption.
C) A historical risk factor increases probability but cannot confirm the diagnosis of the current episode.
E) Placental abruption is principally a clinical diagnosis and does not require ultrasound demonstration of retroplacental bleeding.
Further Reading
RCOG Green-top Guideline No. 63. Antepartum Haemorrhage. Royal College of Obstetricians and Gynaecologists; 2011.