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Question 73
Delivery suite → Haemorrhage
Classification
Question
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A woman at 35+2 weeks presents with an episode of antepartum haemorrhage greater than spotting. Maternal observations and CTG are reassuring, but she continues to have a small amount of vaginal bleeding. What is the most appropriate disposition?
Question Stem
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Options
A
Discharge immediately with routine antenatal follow-up
B
Discharge once the initial CTG is normal
C
Remain in hospital until the bleeding has stopped
D
Arrange outpatient ultrasound and discharge regardless of ongoing bleeding
E
Discharge after administration of anti-D immunoglobulin
Explanation
Women with APH greater than spotting or with ongoing bleeding should remain in hospital at least until the bleeding has stopped. A reassuring initial maternal and fetal assessment does not remove the risk of recurrent or increasing haemorrhage. Decisions regarding subsequent discharge should incorporate the cause and severity of bleeding, maternal and fetal condition, gestation and individual circumstances. Anti-D prophylaxis where indicated and ultrasound assessment do not themselves determine suitability for discharge.
Option Validity
A) ongoing bleeding greater than spotting warrants continued hospital observation.
B) a normal CTG does not by itself make discharge appropriate while bleeding continues.
D) outpatient investigation should not replace observation of continuing APH.
E) anti-D prophylaxis does not determine whether a woman with ongoing bleeding is safe for discharge.
Further Reading
RCOG Green-top Guideline No. 63. Antepartum Haemorrhage. Royal College of Obstetricians and Gynaecologists; 2011.