SBA — Single Best Answer · Review
Question 67
Delivery suite → Haemorrhage
Classification
Question
SSBAQuestion Header
A woman at 37 weeks presents with a significant placental abruption. Maternal resuscitation has commenced. CTG demonstrates persistent fetal bradycardia and vaginal examination shows that vaginal birth is not imminent. What is the most appropriate obstetric management?
Question Stem
—
Options
A
Continue CTG for another 30 minutes
B
Perform fetal blood sampling
C
Commence tocolysis
D
Expedite delivery by caesarean section
E
Await spontaneous labour after maternal stabilisation
Explanation
APH associated with fetal compromise requires urgent delivery. Maternal resuscitation and assessment should occur simultaneously, but where the fetus is compromised and vaginal birth is not imminent, delivery should be expedited, usually by caesarean section. Persistent fetal bradycardia in the context of significant placental abruption represents an obstetric emergency. Tocolysis is inappropriate when delivery is indicated because of maternal or fetal compromise.
Option Validity
A) . persistent fetal bradycardia with significant abruption requires urgent action.
B) . fetal blood sampling would delay indicated delivery.
C) . tocolysis is inappropriate in the presence of fetal compromise requiring delivery.
E) . expectant management is inappropriate with persistent fetal compromise.
Further Reading
RCOG Green-top Guideline No. 63. Antepartum Haemorrhage. Royal College of Obstetricians and Gynaecologists; 2011.