SBA — Single Best Answer · Review
Question 68
Delivery suite → Haemorrhage
Classification
Question
SSBAQuestion Header
A multiparous woman attends for pre-pregnancy counselling after a pregnancy complicated by placental abruption. Which aspect of her history is most important when assessing her risk of placental abruption in a subsequent pregnancy?
Question Stem
—
Options
A
Previous placental abruption
B
Previous uncomplicated forceps delivery
C
Previous postpartum haemorrhage due to uterine atony
D
Previous third-degree perineal tear
E
Previous manual removal of placenta
Explanation
Previous placental abruption is one of the strongest recognised risk factors for recurrence in a subsequent pregnancy. Women with a history of abruption therefore warrant appropriate counselling and antenatal surveillance. Other recognised associations include hypertensive disorders, smoking, cocaine use, abdominal trauma, fetal growth restriction and some thrombophilias. The alternative obstetric events listed do not independently confer the same established recurrence risk for placental abruption.
Option Validity
B) . previous operative vaginal delivery is not an established major risk factor for placental abruption.
C) . previous atonic postpartum haemorrhage does not confer the characteristic recurrence risk associated with previous abruption.
D) . previous obstetric anal sphincter injury is unrelated to placental abruption risk.
E) . previous manual removal of placenta is not a recognised major predictor of subsequent placental abruption.
Further Reading
RCOG Green-top Guideline No. 63. Antepartum Haemorrhage. Royal College of Obstetricians and Gynaecologists; 2011.