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Question 70
Delivery suite → Haemorrhage
Classification
Question
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A woman at 33 weeks presents with her first episode of painless antepartum haemorrhage. Her previous ultrasound report is unavailable. She is haemodynamically stable. What is the principal role of ultrasound in the immediate investigation of this presentation?
Question Stem
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Options
A
Exclude placental abruption
B
Quantify the volume of maternal blood loss
C
Determine placental location
D
Determine the volume of fetomaternal haemorrhage
E
Exclude maternal coagulopathy
Explanation
Ultrasound should be used to establish placental location when this is not already known and placenta praevia is a possible cause of APH. Its role in diagnosing placental abruption is limited because ultrasound has poor sensitivity and a normal scan cannot exclude abruption. Maternal blood loss and haemodynamic compromise require clinical assessment, fetomaternal haemorrhage is assessed using appropriate laboratory testing such as the Kleihauer test where indicated, and coagulopathy requires blood investigations.
Option Validity
A) . ultrasound cannot reliably exclude placental abruption.
B) . ultrasound does not quantify maternal haemorrhage.
D) . fetomaternal haemorrhage requires laboratory assessment rather than placental ultrasound.
E) . maternal coagulopathy is assessed using blood tests.
Further Reading
RCOG Green-top Guideline No. 63. Antepartum Haemorrhage. 2011.