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Question 75
Delivery suite → Haemorrhage
Classification
Question
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A woman at 29 weeks has a significant episode of unexplained antepartum haemorrhage. Placenta praevia has been excluded and the bleeding resolves. Maternal and fetal assessments remain reassuring. What alteration to her subsequent antenatal care is most appropriate?
Question Stem
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Options
A
Return immediately to routine low-risk antenatal care
B
Serial ultrasound assessment of fetal growth
C
Weekly amniocentesis for fetal lung maturity
D
Routine elective delivery at 34 weeks
E
Daily Kleihauer testing until delivery
Explanation
Pregnancies complicated by placental abruption or unexplained APH should subsequently be regarded as higher risk because of an increased risk of adverse outcomes, including fetal growth restriction. Serial ultrasound assessment of fetal growth is therefore appropriate. A resolved episode does not automatically require elective preterm delivery. Kleihauer testing has a specific role in assessing fetomaternal haemorrhage where indicated and is not a surveillance test for fetal growth.
Option Validity
A) significant unexplained APH warrants reclassification as a higher-risk pregnancy.
C) serial amniocentesis has no role in routine surveillance after APH.
D) APH alone does not mandate elective delivery at 34 weeks.
E) repeated Kleihauer testing is not a method of longitudinal fetal growth surveillance.
Further Reading
RCOG Green-top Guideline No. 63. Antepartum Haemorrhage. 2011.