SBA — Single Best Answer · Review
Question 74
Delivery suite → Haemorrhage
Classification
Question
SSBAQuestion Header
A woman at 30 weeks reports a single episode of minimal vaginal spotting. Placenta praevia has been excluded. The bleeding has completely stopped, maternal observations are normal and fetal assessment is reassuring. No other risk factors are identified. Which management is most appropriate?
Question Stem
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Options
A
Mandatory admission until delivery
B
Immediate induction of labour
C
Consider discharge after reassuring assessment
D
Caesarean delivery because any APH predicts fetal compromise
E
Begin therapeutic anticoagulation before discharge
Explanation
A woman presenting with spotting that has stopped, where placenta praevia has been excluded and maternal and fetal assessments are reassuring, may be considered for discharge after appropriate evaluation. Management should be individualised, with clear advice regarding recurrent bleeding and when to seek urgent review. This differs from ongoing bleeding or haemorrhage greater than spotting, for which inpatient observation is generally appropriate until bleeding has ceased.
Option Validity
A) isolated resolved spotting does not mandate admission for the remainder of pregnancy.
B) resolved minor spotting with reassuring assessment is not an indication for immediate delivery.
D) APH does not automatically require caesarean birth.
E) therapeutic anticoagulation is not treatment for uncomplicated resolved APH.
Further Reading
RCOG Green-top Guideline No. 63. Antepartum Haemorrhage. 2011.