Common cause of antepartum hemorrhage?

KPSC Staff Nurse - 2016

Obstetrics & Gynaecology

Easy

Appeared in: KPSC Staff Nurse - 2016

Explanation

Placenta previa is a condition where the placenta implants in the lower uterine segment, partially or completely covering the cervix.
It is a primary cause of antepartum hemorrhage, accounting for about one-third of all cases.
The classic symptom is painless, bright-red vaginal bleeding in the second or third trimester.
As the lower uterine segment remodels and the cervix dilates, the placental attachment is disrupted, leading to bleeding from maternal vessels.

Option A: Vasa previa is a very rare cause of antepartum hemorrhage, with an incidence of about 1 in 2500 to 1 in 5000 pregnancies. The bleeding is fetal, not maternal, which makes it extremely dangerous for the fetus but less common overall than placenta previa.
Option C: Uterine rupture is a rare but catastrophic obstetric emergency, not a common cause of APH. Its incidence is low, typically occurring in women with a prior uterine scar (like a previous C-section).
Option D: This option is incorrect because a common cause of antepartum hemorrhage, Placenta Previa, is listed as one of the options.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain The question tests the knowledge of common causes of antepartum hemorrhage (APH) as background academic context rather than a clinical decision trigger.
A cardinal rule in obstetrics is to never perform a digital vaginal examination on a woman with third-trimester bleeding until placenta previa has been ruled out by ultrasound. A digital exam can provoke catastrophic hemorrhage.
Any woman presenting with bleeding after 20 weeks of gestation requires immediate evaluation, including assessment of maternal vital signs, fetal heart rate monitoring, and an ultrasound for placental localization.
Management of placenta previa depends on gestational age, and the severity of bleeding. If bleeding is severe or the fetus is mature, immediate cesarean delivery is often necessary.

How to Approach the Question

First, understand the question's core concept: 'common cause of antepartum hemorrhage (APH)'.
Define APH: Bleeding from the genital tract after 20-24 weeks of pregnancy.
Recall the main causes of APH. The two most significant causes are Placenta Previa and Abruptio Placentae. Other causes like vasa previa and uterine rupture are much rarer.
Evaluate the given options: 'Vasa praevia', 'Placenta previa', and 'Uterine rupture'.
Compare the incidence of the options. Placenta previa is a well-known common cause, while vasa previa and uterine rupture are known to be rare.
Conclude that 'Placenta previa' is the most fitting answer for a 'common cause' among the choices provided.

Concept Tested & Keywords

Concept Tested: The question tests the knowledge of common causes of antepartum hemorrhage (APH).
Stem keywords: Common cause, antepartum hemorrhage
Lead-in keywords: BEST, MOST RELEVANT CLUE

QGwgb58TWzDEEQmAFOx7VI

E6 Obstetrics Williams p. 48-68

E6 Midwifery Obstetrics and Gynecology Nursing Sandeep Kaur p. 19-27