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Question 80
Delivery suite → Haemorrhage
Classification
Question
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A woman at 39 weeks with a history of antepartum haemorrhage enters spontaneous labour. She has a further episode of vaginal bleeding during labour. Maternal observations are stable. What is the most appropriate method of fetal monitoring?
Question Stem
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Options
A
Intermittent auscultation every 30 minutes
B
Maternal perception of fetal movements alone
C
Continuous electronic fetal monitoring
D
Admission CTG followed by no further monitoring if normal
E
Ultrasound assessment every two hours instead of CTG
Explanation
Active vaginal bleeding during labour represents an increased risk to fetal wellbeing and continuous electronic fetal monitoring is appropriate. APH may reflect placental pathology and can be associated with acute fetal compromise. A reassuring initial trace does not remove the need for ongoing surveillance while the clinical risk persists. Intermittent auscultation is therefore inadequate in the presence of active intrapartum bleeding.
Option Validity
A) intermittent auscultation is insufficient when active APH creates an ongoing risk of fetal compromise.
B) maternal perception of fetal movement cannot replace intrapartum fetal heart monitoring.
D) a normal admission CTG does not eliminate the continuing risk associated with active bleeding.
E) intermittent ultrasound is not a substitute for continuous electronic fetal monitoring during labour.
Further Reading
RCOG Green-top Guideline No. 63. Antepartum Haemorrhage. 2011.