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Question 72
Delivery suite → Haemorrhage
Classification
Question
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A woman at 31+5 weeks presents with painful uterine contractions and antepartum haemorrhage. Placental abruption is suspected. CTG demonstrates persistent fetal compromise. Which statement regarding tocolysis is most appropriate?
Question Stem
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Options
A
Tocolysis should be given routinely because she is below 34 weeks
B
Tocolysis should be commenced before maternal assessment
C
Tocolysis is contraindicated when delivery is indicated because of fetal compromise
D
Tocolysis should continue until a complete course of corticosteroids has been administered
E
Tocolysis is indicated because placental abruption responds to uterine relaxation
Explanation
Tocolysis should not be used when maternal or fetal compromise provides an indication for delivery. Although selected women with APH and uterine activity may occasionally be considered for tocolysis, the decision requires senior obstetric assessment and careful exclusion of contraindications. In this case, persistent fetal compromise in suspected placental abruption requires expedited management rather than pharmacological prolongation of pregnancy. The potential benefit of corticosteroid administration does not justify delaying an indicated delivery.
Option Validity
A) . gestational age alone does not justify tocolysis in APH.
B) . maternal and fetal assessment must precede any decision about tocolysis.
D) . delivery should not be delayed solely to complete corticosteroids when fetal compromise is present.
E) . suspected abruption with fetal compromise is not an indication for routine uterine relaxation.
Further Reading
RCOG Green-top Guideline No. 63. Antepartum Haemorrhage. Royal College of Obstetricians and Gynaecologists; 2011.