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Blunt abdominal trauma in late pregnancy — MRCEM SBA MCQ

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HardTraumaBlunt abdominal trauma in late pregnancyMRCEM SBA

A 30-year-old woman at 30 weeks’ gestation attends the emergency department 90 minutes after a road traffic collision. Her seat belt compressed her abdomen. Her primary survey is normal and she is haemodynamically stable, but she has persistent uterine tenderness and intermittent tightenings. There is no vaginal bleeding. Bedside ultrasound confirms a fetal heartbeat and shows no retroplacental collection. She is RhD-negative, has no immune anti-D antibodies, and received routine antenatal anti-D at 28 weeks. The fetal RhD status is unknown. What is the most appropriate next management plan?

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

Reveal the answer and explanation

Correct answer: A — Arrange obstetric review and CTG; send a Kleihauer sample, give anti-D and admit for observation.

Maternal stability permits assessment of the fetus, but it does not settle the obstetric risk. Abdominal compression followed by persistent uterine tenderness and tightenings raises concern for evolving placental injury. Ultrasound is poorly sensitive for placental abruption: a fetal heartbeat and no visible retroplacental collection do not make discharge safe. At 30 weeks, CTG is indicated, and the continuing symptoms warrant obstetric review and observation. ([rcog.org.uk](https://www.rcog.org.uk/media/pwdi1tef/gtg_63.pdf)) Abdominal trauma is also a potentially sensitising event. In an unsensitised RhD-negative woman beyond 20 weeks, a Kleihauer test assesses fetomaternal haemorrhage and whether additional anti-D is needed; the initial anti-D dose should not be delayed while that result is awaited. Routine prophylaxis at 28 weeks does not replace management of a subsequent event. ([gloshospitals.nhs.uk](https://www.gloshospitals.nhs.uk/our-services/services-we-offer/pathology/tests-and-investigations/kleihauer-test/)) **B** incorrectly waits for the Kleihauer result before giving anti-D. **C** gives appropriate initial prophylaxis but treats one reassuring CTG as sufficient despite persistent symptoms. **D** substitutes repeat ultrasound for CTG, although ultrasound cannot reliably exclude abruption or assess the evolving fetal heart-rate pattern. **E** mistakes routine antenatal prophylaxis for adequate treatment of this new potentially sensitising event. ([rcog.org.uk](https://www.rcog.org.uk/media/pwdi1tef/gtg_63.pdf))

Reference: RCOG Green-top Guideline No. 63: Antepartum Haemorrhage (2011) — https://www.rcog.org.uk/media/pwdi1tef/gtg_63.pdf Antenatal Cardiotocography (CTG) and Dawes Redman Analysis Clinical Guideline (July 2025) — https://doclibrary-rcht.cornwall.nhs.uk/DocumentsLibrary/RoyalCornwallHospitalsTrust/Clinical/MidwiferyAndObstetrics/AntenatalCardiotocographyCTGAnd-DawesRedmanAnalysisClinicalGuideline.pdf Kleihauer test (18 May 2026) — https://www.gloshospitals.nhs.uk/our-services/services-we-offer/pathology/tests-and-investigations/kleihauer-test/