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Question 63
Delivery suite → Haemorrhage
Classification
Question
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A 35-year-old woman at 36+2 weeks presents with sudden abdominal pain and vaginal bleeding. The uterus is tense and tender. CTG shows fetal tachycardia with recurrent late decelerations. Ultrasound shows a normally situated placenta with no retroplacental clot. What is the most appropriate interpretation?
Question Stem
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Options
A
Placental abruption is excluded
B
Placental abruption is unlikely without heavy bleeding
C
Placental abruption remains the likely clinical diagnosis
D
MRI is required to establish the diagnosis
E
Kleihauer testing should confirm the diagnosis
Explanation
Placental abruption is principally a clinical diagnosis. Ultrasound has poor sensitivity for detecting retroplacental haemorrhage; therefore, a negative ultrasound does not exclude abruption. Pain, uterine tenderness or increased tone, vaginal bleeding and fetal compromise should maintain a high clinical suspicion. The volume of visible bleeding may underestimate haemorrhage because bleeding can be concealed. Kleihauer testing assesses fetomaternal haemorrhage rather than diagnosing abruption.
Option Validity
A) . absence of a retroplacental clot does not exclude abruption.
B) . visible blood loss does not reliably indicate severity because bleeding may be concealed.
D) . MRI confirmation is unnecessary; abruption is a clinical diagnosis.
E) . Kleihauer testing assesses fetomaternal haemorrhage rather than diagnosing abruption.
Further Reading
RCOG Green-top Guideline No. 63. Antepartum Haemorrhage. Royal College of Obstetricians and Gynaecologists; 2011.