10.    A woman (para 2 gravida 3) presented at 33 weeks with vaginal bleeding. Her ultrasound scan shows a low-lying placenta. Her first delivery was by lower segment caesarean section and her second was a normal delivery. Her blood group is O rhesus positive.

a)        What is the cause of her bleeding?

           Placenta praevia.

b)         What are the risk factors for this condition? 

            1.    Multiple gestation.

             2.    Previous LSCS.  

             3.    Assisted conception.

             4.    Previous termination of pregnancy.

             5.    Smoking.

             6.    Multiparity.

c)         What would you have found on abdominal examination? 

            1.    Soft uterus.

             2.    High presenting part.

             3.    Malpresentation: unstable / transverse lie.

d)         What would your management of this woman be? Name two aspects.

            1.    Keep in hospital.

             2.    Always have blood available / Group and cross-match.

             3.    IV line.  

e)         How would you deliver her?

            LSCS.

f)          Name three other causes of APH at 33 weeks.

             1.    Abruptio.

             2.    Vasa praevia.        

             3.    Local causes: infection, tumor, trauma to genital tract.