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Question 77
Delivery suite → Haemorrhage
Classification
Question
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A woman at 38 weeks develops a major placental abruption. Despite initial fluid and blood-product resuscitation, she remains hypotensive and tachycardic. The fetal heart is present. What principle should determine the timing of delivery?
Question Stem
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Options
A
Delivery should await complete correction of maternal haemoglobin
B
Delivery should be deferred until ultrasound confirms abruption
C
Maternal compromise is an indication for immediate delivery
D
Delivery should wait until spontaneous labour is established
E
Delivery should be postponed until corticosteroids have been administered
Explanation
In APH associated with maternal haemodynamic compromise, immediate delivery is indicated as part of definitive management while active resuscitation continues. Maternal resuscitation is the priority, but an unstable woman should not have delivery unnecessarily delayed for diagnostic imaging, correction of laboratory values, spontaneous labour or administration of antenatal corticosteroids. Placental abruption remains a clinical diagnosis, and ongoing haemorrhage may continue until the pregnancy is delivered.
Option Validity
A) resuscitation should continue, but delivery should not await normalisation of haemoglobin.
B) placental abruption is a clinical diagnosis and ultrasound confirmation is unnecessary.
D) maternal compromise makes expectant management inappropriate.
E) indicated emergency delivery must not be delayed to administer corticosteroids.
Further Reading
RCOG Green-top Guideline No. 63. Antepartum Haemorrhage. Royal College of Obstetricians and Gynaecologists; 2011.