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Placental abruption — MCCQE Part 1 MCQ

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HardVaginal BleedingPlacental abruptionMCCQE Part 1

28-year-old woman at 35 weeks' gestation presents with painful vaginal bleeding after cocaine use. The uterus is tender and hypertonic and fetal tracing is non-reassuring. Which of the following is the most appropriate next step?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: E — Stabilise mother and arrange urgent delivery with obstetrics

Stabilise mother and arrange urgent delivery with obstetrics is best because painful bleeding with uterine tenderness and fetal compromise suggests abruption. Discharge without pregnancy-specific safety-netting is suboptimal because pregnancy-related bleeding, pain or hypertension can deteriorate quickly; Perform a digital vaginal examination before excluding placenta previa or instability is suboptimal because digital examination can precipitate haemorrhage when placenta previa is possible; Use a medication contraindicated in pregnancy as first-line therapy is suboptimal because maternal treatment must account for fetal safety and gestational age; Delay obstetric or gynaecologic consultation despite red flags is suboptimal because specialist involvement is needed when maternal or fetal risk is present. Abruption can be concealed; bleeding volume may underestimate severity.

Reference: SOGC antepartum haemorrhage guidance