Close help

How to use this Learning Station

On this Learning Station, you can read and test your knowledge. Tap on a book to open its chapter list. In each chapter, you can take a quiz to test your knowledge.

To take tests, you must register with your email address or cell number. It is free to register and to take tests.

For help email or call +27 76 657 0353.

Printed books and CPD points

Learning is easiest with printed books. To order printed books, email or call +27 76 657 0353.

Visit for information.

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).