Quiz 4: Antepartum Haemorrhage

Question 1

What is the definition of an antepartum haemorrhage?

Any vaginal haemorrhage between conception and delivery

Any vaginal haemorrhage during labour

Any vaginal haemorrhage between 24 weeks gestation and delivery

Any vaginal haemorrhage between 24 weeks and the onset of labour

Answer 1

Any vaginal haemorrhage between 24 weeks gestation and delivery

Question 2

Antepartum haemorrhage is an important complication of pregnancy because:

It is a common cause of iron-deficiency anaemia.

The fetus may become anaemic.

It may be due to cervical intra-epithelial neoplasia.

Both the mother and fetus may die.

Answer 2

Both the mother and fetus may die.

Question 3

Which of the following is an important sign of shock due to blood loss?

A fast pulse rate

A low haemoglobin concentration

Concentrated urine

Pyrexia

Answer 3

A fast pulse rate

Question 4

Why is a speculum examination done on a patient with an antepartum haemorrhage?

To see how dilated the cervix is

To exclude a placenta praevia before a digital examination is done

To exclude a local cause of the bleeding from the vagina or cervix

To look for a blood clot in the vagina

Answer 4

To exclude a local cause of the bleeding from the vagina or cervix

Question 5

An antepartum haemorrhage with no fetal heart heard is usually caused by:

Placenta praevia

Abruptio placenta

Antepartum haemorrhage of unknown cause

Trichomonal vaginitis

Answer 5

Abruptio placentae

Question 6

What is the most likely cause of a massive antepartum haemorrhage that threatens the mother’s life?

Abruptio placenta

Rupture of the uterus

Cervical carcinoma

Placenta praevia

Answer 6

Placenta praevia

Question 7

Which of the following factors will place a patient at the highest risk of abruptio placenta?

A history of abruptio placentae in a previous pregnancy.

Any of the hypertensive disorders of pregnancy.

Intra-uterine growth retardation.

Cigarette smoking.

Answer 7

A history of abruptio placentae in a previous pregnancy.

Question 8

Which of the following would suggest an abruptio placenta?

The uterus is tonically contracted and tender.

Fetal movements are usually present.

The haemoglobin concentration is low.

The uterus is relaxed and the fetal parts are easily felt.

Answer 8

The uterus is tonically contracted and tender.

Question 9

Which management would be correct if abruptio placentae with an intra-uterine death was diagnosed?

The fetus must be delivered by Caesarean section.

A vaginal examination must not be done because the patient has had an antepartum haemorrhage.

A vaginal examination must be done to rupture the membranes and, thereby, obtain a vaginal delivery.

The spontaneous onset of labour must be awaited.

Answer 9

A vaginal examination must be done to rupture the membranes and, thereby, obtain a vaginal delivery.

Question 10

Which of the following patients is at an increased risk of placenta praevia?

A patient with one of the hypertensive disorders of pregnancy

A patient with a multiple pregnancy

A patient with intra-uterine growth retardation

A patient who smokes

Answer 10

A patient with a multiple pregnancy

Question 11

Vaginal bleeding due to placenta praevia is usually associated with:

Fetal parts that are difficult to feel and an absent fetal heartbeat

Engagement of the fetal head

A uterus that is relaxed and not tender on palpation

Lower abdominal pain

Answer 11

A uterus that is relaxed and not tender on palpation

Question 12

In which of the following patients can placenta praevia be excluded?

A patient with a slight vaginal bleed

When 2/5 or less of the fetal head can be palpated above the pelvic brim on abdominal examination

A patient with a painless, bright red vaginal bleed

A patient with a breech presentation

Answer 12

When 2/5 or less of the fetal head can be palpated above the pelvic brim on abdominal examination

Question 13

Which of the following will exclude a placenta praevia?

A careful speculum examination

A careful abdominal examination

The presence of fetal distress

Ultrasonography

Answer 13

Ultrasonography

Question 14

Following a small vaginal bleed at 34 weeks gestation, the diagnosis of placenta praevia is confirmed with ultrasonography. Which of the following will be the correct further management?

The fetus must be delivered immediately by Caesarean section.

A vaginal examination must be done in theatre immediately to confirm the diagnosis.

The patient must be hospitalised and managed conservatively until 36 weeks or until active bleeding starts again.

The membranes must be ruptured to induce labour.

Answer 14

The patient must be hospitalised and managed conservatively until 36 weeks or until active bleeding starts again.

Question 15

An antepartum haemorrhage of unknown cause should be suspected:

When the history and abdominal examination are not suggestive of an abruptio placenta

When local causes of bleeding have been excluded by a speculum examination

When a placenta praevia is excluded

When all of the above causes of an antepartum haemorrhage have been excluded

Answer 15

When all of the above causes of an antepartum haemorrhage have been excluded

Question 16

How should you manage a patient with an antepartum haemorrhage of unknown cause?

The patient must be admitted to hospital where fetal movements should be carefully monitored, especially during the first 24 hours.

Because the risk of an abruptio placentae is so great, an emergency Caesarean section must be done.

Once the diagnosis is made, the patient should be discharged and followed up as a low-risk patient.

The patient must be hospitalised until 38 weeks of gestation, when labour should be induced.

Answer 16

The patient must be admitted to hospital where fetal movements should be carefully monitored, especially during the first 24 hours.

Question 17

An antepartum haemorrhage of unknown cause should always be regarded as a serious complication of pregnancy because:

Intra-uterine growth restriction is often present.

It may be caused by cervical cancer.

Abruptio placentae may be present.

Placenta praevia may be present.

Answer 17

Abruptio placentae may be present.

Question 18

Which of the following is typical of a ‘show’?

A vaginal bleed that soaks a sanitary towel

A slight bleed consisting of blood mixed with mucus

A vaginal discharge mixed with blood

Contact bleeding from the cervix caused by a speculum examination

Answer 18

A slight bleed consisting of blood mixed with mucus

Question 19

If a speculum examination is done on a patient with a history suggestive of a blood-stained discharge, what finding would diagnose an antepartum haemorrhage?

Bleeding from a closed cervical os

A blood-stained discharge seen in the vagina

Contact bleeding when the speculum touches the cervix

Bulging membranes through a partially dilated cervix

Answer 19

Bulging membranes through a partially dilated cervix

Question 20

How should you manage a patient who presents at 30 weeks of gestation with a blood-stained vaginal discharge which is caused by vaginitis?

The urine should be tested with a reagent strip for protein, nitrites and leucocytes.

A cytology smear must be taken from the cervix to identify the organism causing the vaginitis.

A vaginal examination should be done in theatre as with any other patient who presents with an antepartum haemorrhage.

The patient and her partner must be treated with metronidazole (Flagyl).

Answer 20

The patient and her partner must be treated with metronidazole (Flagyl).