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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. The initial management of a shocked patient with an antepartum haemorrhage is:
    • A speculum examination to rule out a local cause for the antepartum haemorrhage.
    • An ultrasound examination must be done in order to localise the placenta.
    • Assess whether there is engagement of the fetal head as this could rule out a placenta praevia.
    • Put up two intravenous infusions to run in quickly.
  5. The amount of bleeding to diagnose an antepartum haemorrhage is:
    • A sanitary pad is at least partly soaked with blood.
    • A blood-stained vaginal discharge is present.
    • A small amount of blood mixed with mucus has been passed.
    • Any one of above-mentioned is present.
  6. 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.
  7. 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.
  8. 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.
  9. 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 restriction.
    • Cigarette smoking.
  10. 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 heart rate is normal.
  11. An antepartum haemorrhage with no fetal heart heard is usually caused by:
    • Placenta praevia.
    • Abruptio placentae.
    • Antepartum haemorrhage of unknown cause.
    • Trichomonal vaginitis.
  12. 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 restriction.
    • A patient who smokes.
  13. What symptoms point to the diagnosis of placenta praevia?
    • The bleeding is painless.
    • The bleeding consists of dark red blood clots.
    • The bleeding is associated with severe continuous abdominal pain.
    • Fetal movement is absent after the bleed.
  14. Vaginal bleeding due to placenta praevia is usually associated with:
    • Fetal parts that are difficult to feel and an absent fetal heart beat.
    • Engagement of the fetal head.
    • A uterus that is relaxed and not tender on palpation.
    • Lower abdominal pain.
  15. In which of the following patients can placenta praevia be excluded?
    • A patient with a slight vaginal bleed.
    • When two fifths 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.
  16. What action should you take if a routine ultrasound examination early in pregnancy shows a placenta praevia?
    • A repeat ultrasound examination must be arranged at 32 weeks.
    • No further investigations are required.
    • Book the patient for an elective Caesarean section at 38 weeks.
    • Refer the patient to hospital where she will be admitted.
  17. How will a patient describe a blood-stained vaginal discharge?
    • A vaginal bleed that soaks a sanitary towel.
    • A slight bleed consisting of blood mixed with mucus.
    • A vaginal discharge mixed with a small amount of blood.
    • Bleeding after intercourse.
  18. Which of the following is typical of a ‘show’?
    • A heavy vaginal bleed.
    • A slight bleed consisting of blood mixed with mucus.
    • A mucoid vaginal discharge.
    • Blood in the urine.
  19. What would you find on speculum examination with a history of a ‘show’?
    • The cervix is a few centimetres dilated and the membranes are bulging.
    • The bleeding will come through a closed cervical os.
    • An offensive vaginal discharge.
    • Contact bleeding will occur if the cervix is touched.
  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).