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Question 66
Delivery suite → Haemorrhage
Classification
Question
SSBAQuestion Header
A woman at 32+4 weeks presents with a moderate antepartum haemorrhage. Bleeding has settled following initial assessment, but the obstetric team considers her at increased risk of preterm delivery. Which intervention is most appropriate?
Question Stem
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Options
A
Routine prophylactic antibiotics
B
Antenatal corticosteroids
C
Immediate induction of labour
D
Routine therapeutic anticoagulation
E
Delay treatment until recurrent bleeding occurs
Explanation
RCOG recommends that women presenting with APH between 24+0 and 34+6 weeks who are considered at increased risk of preterm birth should receive a course of antenatal corticosteroids. APH may precede preterm delivery, particularly when associated with placental pathology. Corticosteroid administration should therefore be considered on the basis of gestation and likelihood of preterm birth rather than waiting for recurrent haemorrhage.
Option Validity
A) . APH alone is not an indication for routine prophylactic antibiotics.
C) . stable APH does not automatically require immediate delivery.
D) . therapeutic anticoagulation is inappropriate solely because APH has occurred.
E) . corticosteroids should be given when preterm birth risk is increased rather than waiting for another bleed.
Further Reading
RCOG Green-top Guideline No. 63. Antepartum Haemorrhage. 2011.