Which is not a cause of APH?

Appeared in: Chitranjjan National Cancer Institute Kolkata - 2021

Explanation

Cord presentation is a fetal malpresentation where the umbilical cord is positioned below the presenting part of the fetus while the membranes are intact.
This condition does not inherently cause vaginal bleeding from the genital tract and is therefore not a cause of Antepartum Hemorrhage (APH).
The primary risk associated with cord presentation is umbilical cord prolapse if the membranes rupture. This can lead to cord compression and fetal hypoxia, which is an obstetric emergency but is not related to maternal hemorrhage.

Option A: Placenta previa is a primary and common cause of APH. It occurs when the placenta implants in the lower uterine segment, partially or completely covering the cervix.
Option C: Abruptio placentae, the premature separation of a normally implanted placenta, is another major cause of APH.
Option D: Rupture of the uterus is a catastrophic cause of hemorrhage. While it often occurs during labor (intrapartum), it can occur before labor begins, especially in a scarred uterus, thus qualifying as a cause of APH.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Causes of Antepartum Hemorrhage (APH) as background academic context rather than a clinical decision trigger.
Correctly identifying the cause of APH is critical for timely and appropriate emergency management to save both maternal and fetal lives.
A crucial nursing intervention in any case of APH is to establish large-bore IV access, monitor vital signs, assess for shock, and prepare for potential blood transfusion and emergency delivery.
In cases of suspected placenta previa (painless bleeding), digital vaginal examinations are strictly contraindicated as they can provoke catastrophic hemorrhage.

How to Approach the Question

First, identify the negative framing of the question, which asks what is 'NOT' a cause of APH.
Define Antepartum Hemorrhage (APH): vaginal bleeding occurring after 24 weeks of gestation and before the onset of labor.
Evaluate each option against this definition.
Recall that placenta previa and abruptio placentae are the two most common causes of APH.
Consider uterine rupture. While often associated with labor, it can occur before labor starts, causing antepartum bleeding.
Analyze cord presentation. This is a malpresentation of the umbilical cord. It does not cause bleeding itself; its danger is cord prolapse and compression.

Concept Tested & Keywords

Concept Tested: Causes of Antepartum Hemorrhage (APH)
Stem keywords: APH, cause
Lead-in keywords: not
Negative lead-in flag: The question asks to identify the option that is NOT a cause of Antepartum Hemorrhage (APH).

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E6 Obstetrics Williams p. 57-76

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Attempt every question from this paper in a timed mock, then review the full solution for each one.