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Question 96
Delivery suite → Haemorrhage
Classification
Question
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A woman at 37 weeks presents with placental abruption. Ultrasound confirms intrauterine fetal death. Following initial resuscitation she is haemodynamically stable, bleeding is controlled and there is no contraindication to vaginal birth. What is the preferred mode of delivery?
Question Stem
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Options
A
Immediate caesarean section in all cases
B
Vaginal delivery
C
Classical caesarean section
D
Caesarean section after correction of haemoglobin
E
Delivery should be deferred for 48 hours
Explanation
When fetal death has occurred following placental abruption and the mother is haemodynamically stable without another obstetric indication for caesarean birth, vaginal delivery is generally preferred. Caesarean section exposes the mother to operative bleeding and anaesthetic risks without fetal benefit, particularly when abruption may be associated with coagulopathy. Maternal condition remains critical; deterioration, uncontrolled haemorrhage or another obstetric indication may alter management.
Option Validity
A) fetal death alone does not mandate caesarean section, and operative delivery may increase maternal risk.
C) classical caesarean section has no routine role in this situation.
D) caesarean section is not indicated simply because haemoglobin has been corrected.
E) unnecessary delay may expose the mother to continued haemorrhage and coagulopathy.
Further Reading
RCOG Green-top Guideline No. 63. Antepartum Haemorrhage. Royal College of Obstetricians and Gynaecologists; 2011.