SBA — Single Best Answer · Review
Question 97
Delivery suite → Haemorrhage
Classification
Question
SSBAQuestion Header
A woman at 32 weeks presents with a small amount of vaginal bleeding. She is stable and has no abdominal pain. Placenta praevia has been excluded on ultrasound. Which examination is useful for identifying a cervical or lower genital tract source of bleeding?
Question Stem
—
Options
A
Digital rectal examination
B
Speculum examination
C
Routine digital cervical examination
D
Bimanual examination under anaesthesia
E
Amnioscopic examination
Explanation
Speculum examination can help identify non-placental causes of APH arising from the cervix or lower genital tract and may provide information about cervical dilatation. Digital vaginal examination requires particular caution when placenta praevia has not been excluded because manipulation may provoke severe bleeding. In this case placental location is already known, but a speculum examination remains the appropriate targeted examination for identifying a visible local source of bleeding.
Option Validity
A) rectal examination is not the appropriate method for identifying a cervical or vaginal source of APH.
C) digital examination is not the primary examination for visual identification of lower genital tract lesions.
D) examination under anaesthesia is unnecessary in a stable woman requiring routine assessment of a possible local source.
E) amnioscopy is not the appropriate investigation for identifying cervical or vaginal causes of APH.
Further Reading
RCOG Green-top Guideline No. 63. Antepartum Haemorrhage. Royal College of Obstetricians and Gynaecologists; 2011.