Quiz 4: Antepartum haemorrhage

Please choose the one, most correct answer to each question or statement.

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
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.
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
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
An antepartum haemorrhage with no fetal heart heard is usually caused by:
- Placenta praevia
- Abruptio placentae
- Antepartum haemorrhage of unknown cause
- Trichomonal vaginitis
What is the most likely cause of a massive antepartum haemorrhage that threatens the mother’s life?
- Abruptio placentae
- Rupture of the uterus
- Cervical carcinoma
- Placenta praevia
Which of the following factors will place a patient at the highest risk of abruptio placentae?
- A history of abruptio placentae in a previous pregnancy.
- Any of the hypertensive disorders of pregnancy.
- Intra-uterine growth retardation.
- Cigarette smoking.
Which of the following would suggest an abruptio placentae?
- 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.
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.
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
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
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
Which of the following will exclude a placenta praevia?
- A careful speculum examination
- A careful abdominal examination
- The presence of fetal distress
- Ultrasonography
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.
An antepartum haemorrhage of unknown cause should be suspected:
- When the history and abdominal examination are not suggestive of an abruptio placentae
- 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
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.
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.
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
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
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).