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Question 98
Delivery suite → Haemorrhage
Classification
Question
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A nulliparous woman at 34 weeks with pre-eclampsia develops sudden abdominal pain and vaginal bleeding. The uterus is tender and CTG becomes abnormal. Which feature of her history is an established risk factor for the most likely diagnosis?
Question Stem
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Options
A
Pre-eclampsia
B
Nulliparity
C
Previous cervical smear
D
Iron supplementation
E
Epidural analgesia in a previous pregnancy
Explanation
The presentation is strongly suggestive of placental abruption. Hypertensive disorders of pregnancy, including pre-eclampsia, are recognised risk factors for placental abruption. The combination of acute abdominal pain, vaginal bleeding, uterine tenderness and fetal compromise should prompt urgent clinical assessment and management. Importantly, the amount of visible bleeding may underestimate the severity because haemorrhage can be concealed.
Option Validity
B) nulliparity alone is not the relevant established risk factor in this scenario.
C) cervical screening history does not predispose to placental abruption.
D) iron supplementation is unrelated to the development of placental abruption.
E) previous epidural analgesia is not a recognised risk factor for abruption.
Further Reading
RCOG Green-top Guideline No. 63. Antepartum Haemorrhage. Royal College of Obstetricians and Gynaecologists; 2011.