Which of the following can cause excessive hemorrhage during the third trimester?

NHM MP Staff Nurse-2019

Obstetrics & Gynaecology

Easy

Appeared in: NHM MP Staff Nurse-2019

Explanation

Both placenta previa and abruptio placentae are primary causes of excessive hemorrhage during the third trimester of pregnancy.
Placenta previa involves the implantation of the placenta over or near the cervical os, leading to painless, bright red bleeding as the lower uterine segment remodels or the cervix dilates.
Abruptio placentae is the premature separation of a normally implanted placenta, which typically causes painful, dark red bleeding and uterine tenderness.
Since both conditions are major causes of third-trimester bleeding, the correct option encompasses both possibilities.
These conditions are obstetric emergencies requiring immediate medical attention to prevent severe maternal and fetal complications.

Option A: This option is incomplete. While placenta previa is a correct cause of third-trimester hemorrhage, it is not the only cause listed. Abruptio placentae is also a major cause.
Option B: This option is also incomplete. Although abruptio placentae is a correct cause of third-trimester hemorrhage, placenta previa is another significant cause presented in the options.
Option D: This option is incorrect because both placenta previa and abruptio placentae are well-established, classic causes of significant bleeding in the third trimester.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Causes of antepartum hemorrhage in the third trimester of pregnancy as background academic context rather than a clinical decision trigger.
Recognizing the signs and symptoms of placenta previa and abruptio placentae is a critical nursing skill. Prompt identification and intervention can prevent life-threatening maternal hemorrhage and fetal distress.
A key nursing action is to NEVER perform a vaginal examination on a patient with suspected placenta previa and vaginal bleeding, as it can cause catastrophic hemorrhage. An ultrasound must be done first to confirm placental location.
Nurses must be prepared for an obstetric emergency, including establishing large-bore IV access, preparing for blood transfusion, and continuous maternal and fetal monitoring.

How to Approach the Question

First, identify the core of the question: it asks for causes of 'excessive hemorrhage' in the 'third trimester'.
Recall the major obstetric complications associated with late pregnancy bleeding.
Evaluate Option A, 'Placenta previa'. This is a known major cause of painless, bright red bleeding in the third trimester.
Evaluate Option B, 'Abruptio Placenta'. This is another major cause, typically presenting as painful bleeding in the third trimester.
Since both A and B are correct and significant causes, look for an option that includes both.
Option C, 'Both a and b', correctly identifies that both conditions are causes. Therefore, this is the most comprehensive and correct answer.

Concept Tested & Keywords

Concept Tested: Causes of antepartum hemorrhage in the third trimester of pregnancy.
Stem keywords: excessive hemorrhage, third trimester
Lead-in keywords: Which of the following
Clinical cues: The term 'third trimester' is a critical cue, pointing towards late-pregnancy complications like placenta previa and abruptio placentae.

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E6 Obstetrics Williams p. 71-94

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