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Question 76
Delivery suite → Haemorrhage
Classification
Question
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A non-sensitised RhD-negative woman at 30 weeks has recurrent episodes of antepartum haemorrhage. She received anti-D immunoglobulin following an earlier episode three weeks ago. She now presents with another significant bleed. Which statement is most appropriate?
Question Stem
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Options
A
Previous anti-D prophylaxis means no further prophylaxis is required during pregnancy
B
Recurrent APH should be treated as a potentially new sensitising event
C
Anti-D is required only if the CTG is abnormal
D
Anti-D is unnecessary once pregnancy has passed 28 weeks
E
Anti-D should be withheld until after delivery
Explanation
Antepartum haemorrhage is a potentially sensitising event in a non-sensitised RhD-negative woman. Recurrent bleeding therefore requires appropriate consideration of further anti-D prophylaxis in accordance with gestation, timing and assessment of fetomaternal haemorrhage. Previous prophylaxis does not mean that subsequent sensitising events can simply be ignored. The need for anti-D is related to the risk of fetomaternal haemorrhage, not to the fetal heart rate pattern.
Option Validity
A) subsequent sensitising events may require additional anti-D prophylaxis.
C) fetal CTG findings do not determine the indication for anti-D.
D) APH after 28 weeks remains a potentially sensitising event.
E) prophylaxis for an antenatal sensitising event should not routinely be deferred until delivery.
Further Reading
RCOG Green-top Guideline No. 63. Antepartum Haemorrhage. 2011.