EM Vivas · Antepartum haemorrhage
Antepartum haemorrhage — praevia vs abruption
Clinical viva on Antepartum haemorrhage.
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Study tools
Target exams
ACEMFRCEMABEM
Prompt
A 32-week pregnant woman has PV bleeding. How do you distinguish placenta praevia from abruption, and what must you never do on vaginal examination?
Interpretation
Reveal interpretationShowHide
Praevia: painless, bright red bleeding; uterus soft; fetal heart often stable initially; placenta low on ultrasound. Abruption: pain, dark blood (or concealed), woody hard uterus, shock may exceed revealed loss, fetal distress common, DIC risk.
Never perform digital VE until placental site is known — can precipitate catastrophic haemorrhage in praevia. Speculum examination is cautious and usually after ultrasound when feasible. Resuscitate mother and fetus in parallel; activate obstetrics; anti-D if Rh-negative.[1]
References1ShowHide
- [1]Young JS, White LM Vaginal Bleeding in Late Pregnancy. Emerg Med Clin North Am, 2019.PMID 30940370