SBA — Single Best Answer · Review
Question 81
Delivery suite → Haemorrhage
Classification
Question
SSBAQuestion Header
A woman has a vaginal birth following a pregnancy complicated by significant antepartum haemorrhage. Maternal observations are currently stable. What is the most appropriate approach to the third stage of labour?
Question Stem
—
Options
A
Physiological management because antenatal bleeding has ceased
B
Active management because of the increased risk of postpartum haemorrhage
C
Delay uterotonic administration until excessive bleeding occurs
D
Avoid uterotonics because they increase the risk of placental abruption
E
Routine manual removal of the placenta
Explanation
Women who have experienced APH are at increased risk of postpartum haemorrhage. Active management of the third stage should therefore be used to reduce this risk. Waiting until excessive bleeding develops loses the prophylactic benefit of active management. Routine manual removal of the placenta is not indicated, and uterotonic therapy is an integral component of active third-stage management unless a specific contraindication exists.
Option Validity
A) previous APH increases the risk of PPH and favours active third-stage management.
C) uterotonic prophylaxis should not routinely be delayed until haemorrhage develops.
D) uterotonics are used to reduce postpartum haemorrhage risk and do not cause antenatal placental abruption after birth.
E) routine manual removal is not part of prophylactic third-stage management.
Further Reading
RCOG Green-top Guideline No. 63. Antepartum Haemorrhage. 2011.