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Test 4: Antepartum haemorrhage

  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
  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.
  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
  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
  5. An antepartum haemorrhage with no fetal heart heard is usually caused by:
    • Placenta praevia
    • Abruptio placentae
    • Antepartum haemorrhage of unknown cause
    • Trichomonal vaginitis
  6. 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
  7. 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.
  8. 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.
  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.
  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
  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
  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
  13. Which of the following will exclude a placenta praevia?
    • A careful speculum examination
    • A careful abdominal examination
    • The presence of fetal distress
    • Ultrasonography
  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.
  15. 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
  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.
  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.
  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
  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
  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).