A 31-year-old primigravida at 36 weeks with BP 170/112 mm Hg and proteinuria 3+ develops sudden abdominal pain and dark vaginal bleeding in the labour room. The uterus is tense and tender, and the fetal heart rate has been 90/min for 8 minutes. The cervix is closed and uneffaced. Which management is most appropriate?

Magnesium sulphate, BP control, emergency caesarean

Stabilise for 24 hours, then plan delivery

Labetalol, then induction with misoprostol

Magnesium sulphate and amniotomy for a vaginal birth

A transvaginal scan at 34 weeks in a 28-year-old second gravida shows a posterior placenta whose lower edge reaches the margin of the internal os without covering it. In the older grading taught in Indian textbooks this is a type II posterior placenta previa, often called the 'dangerous' type. What makes it dangerous?

It narrows the inlet and is compressed by the head

It bleeds only in labour, so it is found late

It is the type most often linked with vasa previa

It is the type most often complicated by placenta accreta

A 26-year-old second gravida at 29 weeks with known placenta previa is admitted with heavy painless bleeding that continues after 2 units of blood and 2 litres of fluid. Pulse is 130/min and BP 80/50 mm Hg; the fetal heart rate is 150/min. What is the next step?

Tocolysis and steroids, then wait

Induction of labour with misoprostol

A 25-year-old primigravida at 30 weeks is brought to casualty after falling from a two-wheeler. She has bruises over the abdomen but no bleeding or pain, the uterus is soft and the fetal heart rate is 146/min. Her vital signs are normal. What is the most appropriate next step for the pregnancy?

Continuous CTG monitoring for at least 4 hours

Single ultrasound, with discharge if normal

Discharge with advice to count fetal kicks

Antepartum haemorrhage: placenta previa, abruption, vasa previa

33 NEET-PG practice questions on Antepartum haemorrhage: placenta previa, abruption, vasa previa, part of Obstetrics & Gynaecology. The first 25 are below; the first 5 with answers and explanations (tap Show answer after you have chosen), the rest in Learn with a free account.

Question 1 · Medium
A 30-year-old third gravida at 33 weeks comes to casualty after waking up in a pool of painless, bright red vaginal bleeding. Pulse is 92/min and BP 116/74 mm Hg; the uterus is soft and non-tender, the presenting part is high and the fetal heart rate is 144/min. The bleeding has now settled. What is the investigation of choice to locate the placenta?
1. ADigital vaginal examination
2. BTransabdominal ultrasonography
3. CMRI of the pelvis
4. DTransvaginal ultrasonography
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Answer: D · Transvaginal ultrasonography
Painless, causeless, recurrent bright red bleeding with a soft uterus and a high presenting part suggests placenta previa. Transvaginal ultrasound is the investigation of choice: it measures the distance from the placental edge to the internal os more accurately than the abdominal route, and it is safe because the probe stays in the vagina at an angle to the cervix. A digital examination is avoided because it can provoke torrential bleeding, and is done only in theatre with a double set-up. As she is stable at 33 weeks she is managed expectantly, with corticosteroids, blood kept ready and anti-D if she is Rh negative.
- A: Digital examination can start torrential bleeding in placenta previa.
- B: Abdominal scanning is less accurate, especially for a posterior placenta.
- C: MRI is used to assess suspected placenta accreta, not first-line localisation.
Question 2 · Hard
A 31-year-old primigravida at 36 weeks with BP 170/112 mm Hg and proteinuria 3+ develops sudden abdominal pain and dark vaginal bleeding in the labour room. The uterus is tense and tender, and the fetal heart rate has been 90/min for 8 minutes. The cervix is closed and uneffaced. Which management is most appropriate?
1. AStabilise for 24 hours, then plan delivery
2. BLabetalol, then induction with misoprostol
3. CMagnesium sulphate, BP control, emergency caesarean
4. DMagnesium sulphate and amniotomy for a vaginal birth
Show answerHide answer
Answer: C · Magnesium sulphate, BP control, emergency caesarean
She has severe pre-eclampsia complicated by abruption, and the fetus has prolonged bradycardia with a closed cervix, so vaginal delivery would be far too slow. Magnesium sulphate prevents eclampsia, and BP above 160/110 mm Hg must be lowered quickly (IV labetalol or oral nifedipine) to reduce the risk of stroke, while she goes for an emergency caesarean. A coagulation screen and cross-matched blood are sent at once. Amniotomy suits a dead fetus or a favourable cervix, not a distressed fetus with a closed cervix.
- A: Waiting 24 hours with fetal bradycardia risks fetal death.
- B: Induction from a closed cervix is too slow for fetal bradycardia.
- D: Amniotomy cannot deliver a distressed fetus from a closed cervix.
Question 3 · Medium
A transvaginal scan at 34 weeks in a 28-year-old second gravida shows a posterior placenta whose lower edge reaches the margin of the internal os without covering it. In the older grading taught in Indian textbooks this is a type II posterior placenta previa, often called the 'dangerous' type. What makes it dangerous?
1. AIt bleeds only in labour, so it is found late
2. BIt narrows the inlet and is compressed by the head
3. CIt is the type most often linked with vasa previa
4. DIt is the type most often complicated by placenta accreta
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Answer: B · It narrows the inlet and is compressed by the head
A posterior placenta lying over the sacral promontory reduces the anteroposterior diameter of the inlet and prevents the head from engaging. When the head descends it compresses the placenta against the sacrum, cutting off placental blood flow and causing fetal hypoxia, and the cord may also be compressed. This is why the posterior marginal type was called dangerous in the older classification. Current practice describes the distance of the placental edge from the os instead of these grades.
- A: Any previa can bleed before labour, including this type.
- C: Vasa previa relates to cord insertion, not this placental type.
- D: Accreta risk depends on a uterine scar, mostly anterior.
Question 4 · Medium
A 26-year-old second gravida at 29 weeks with known placenta previa is admitted with heavy painless bleeding that continues after 2 units of blood and 2 litres of fluid. Pulse is 130/min and BP 80/50 mm Hg; the fetal heart rate is 150/min. What is the next step?
1. ATocolysis and steroids, then wait
2. BEmergency caesarean section
3. CInduction of labour with misoprostol
4. DVaginal examination in theatre
Show answerHide answer
Answer: B · Emergency caesarean section
Expectant management is abandoned when bleeding is heavy and continuing or the mother is unstable, whatever the gestation, because the mother's life comes first. Emergency caesarean by a senior team, with massive transfusion support, is the definitive treatment. Corticosteroids can be given if time allows, but they must not delay delivery. Vaginal examination and induction have no place in major placenta previa.
- A: Waiting while she is in shock risks maternal death.
- C: Vaginal delivery is impossible with a placenta over the os.
- D: A double set-up examination is obsolete with ultrasound.
Question 5 · Medium
A 25-year-old primigravida at 30 weeks is brought to casualty after falling from a two-wheeler. She has bruises over the abdomen but no bleeding or pain, the uterus is soft and the fetal heart rate is 146/min. Her vital signs are normal. What is the most appropriate next step for the pregnancy?
1. AContinuous CTG monitoring for at least 4 hours
2. BImmediate caesarean section
3. CSingle ultrasound, with discharge if normal
4. DDischarge with advice to count fetal kicks
Show answerHide answer
Answer: A · Continuous CTG monitoring for at least 4 hours
Even minor abdominal trauma can shear the placenta from the uterine wall, and abruption may appear hours later. After trauma beyond viability, continuous fetal heart and contraction monitoring for at least 4 hours is advised; frequent contractions, tenderness, bleeding or an abnormal trace call for longer observation. Ultrasound often misses abruption, so a normal scan does not allow discharge. An Rh-negative woman also needs anti-D and a Kleihauer test.
- B: There is no indication for delivery in a stable mother and fetus.
- C: Ultrasound is insensitive for abruption and cannot replace monitoring.
- D: Discharge without monitoring misses a delayed abruption.
Question 6 · Medium
A 25-year-old second gravida at 37 weeks comes to the labour room with mild abdominal pain and a small dark bleed. Pulse is 88/min and BP 120/80 mm Hg. The uterus is slightly tender between contractions, the CTG is reassuring, the placenta is fundal on ultrasound and the cervix is 5 cm dilated with a vertex at 1/5 palpable. Blood counts and fibrinogen are normal. What is the most appropriate management?
1. ATocolysis to stop the contractions
2. BDischarge home with daily fetal kick counts
3. CAmniotomy and oxytocin, continuous CTG
4. DEmergency caesarean section
Answer and explanation in LearnFree account
Question 7 · Easy
A 32-year-old fourth gravida at 34 weeks, admitted to a district hospital with pre-eclampsia, suddenly develops severe continuous abdominal pain with a small amount of dark vaginal bleeding. Pulse is 118/min and BP 100/70 mm Hg. The uterus is tense and tender, fetal parts are difficult to feel and the fetal heart rate is 100/min. What is the most likely diagnosis?
1. AAbruptio placentae
2. BVasa previa
3. CPlacenta previa
4. DRupture of the uterus
Answer and explanation in LearnFree account
Question 8 · Easy
At her booking visit at an ANC clinic, a 31-year-old third gravida at 12 weeks asks whether she is at risk of bleeding from a low placenta later in pregnancy. Which item in her history most increases the risk of placenta previa?
1. ATwo previous caesarean deliveries
2. BGestational diabetes in her last pregnancy
3. CRh D-negative blood group
4. DPre-eclampsia in her last pregnancy
Answer and explanation in LearnFree account
Question 9 · Medium
A 35-year-old fifth gravida is admitted to a district hospital with a severe concealed abruption and fetal death. The resident lists complications to watch for: 1. Consumptive coagulopathy. 2. Postpartum haemorrhage. 3. Acute kidney injury. 4. Sheehan syndrome later. Which of these are recognised complications of severe abruption?
1. A1 and 2 only
2. B2, 3 and 4 only
3. C1, 2, 3 and 4
4. D1, 2 and 3 only
Answer and explanation in LearnFree account
Question 10 · Hard
A 27-year-old IVF primigravida at 39 weeks is in labour at 5 cm when the membranes rupture spontaneously, followed by a brisk fresh bleed. The fetal heart rate falls to 90/min for 3 minutes, then the CTG shows a smooth, regular sine-wave pattern of about 3-5 cycles per minute with absent variability. Maternal pulse is 84/min and BP 122/78 mm Hg. What is the next step?
1. AImmediate caesarean with the neonatal team ready
2. BOxytocin augmentation to speed vaginal birth
3. CUltrasound to locate the placenta first
4. DApt test, then decide on the mode of delivery
Answer and explanation in LearnFree account
Question 11 · Hard
A 34-year-old fourth gravida with three previous caesareans has an anterior placenta previa covering the os. At 30 weeks, ultrasound shows loss of the clear zone behind the placenta, multiple placental lacunae with turbulent flow, and interruption of the bladder line with bridging vessels. She has had no bleeding. What is the most appropriate delivery plan?
1. ACaesarean with manual removal of the placenta
2. BAwait spontaneous labour and vaginal delivery at term
3. CCaesarean hysterectomy with the placenta left in situ
4. DLower segment incision through the placenta
Answer and explanation in LearnFree account
Question 12 · Medium
A 30-year-old primigravida who conceived by IVF has her 20-week anomaly scan, which shows a low-lying placenta with a velamentous cord insertion. Which investigation should be done to look for vasa previa?
1. AMRI of the placenta
2. BAmniocentesis with an Apt test
3. CRepeat abdominal scan at term
4. DTransvaginal ultrasound with colour Doppler
Answer and explanation in LearnFree account
Question 13 · Medium
A 28-year-old second gravida at 32 weeks with a placenta previa covering the os is admitted after a moderate painless bleed. The duty resident lists four conditions for continuing expectant (Macafee) management: 1. The mother is haemodynamically stable and bleeding has settled. 2. The pregnancy is below 37 weeks. 3. The fetus is alive with a reassuring heart rate. 4. She is in established labour. Which conditions must be present?
1. A1, 2, 3 and 4
2. B2 and 4 only
3. C1, 2 and 3 only
4. D1 and 3 only
Answer and explanation in LearnFree account
Question 14 · Medium
A 30-year-old second gravida with one previous vaginal birth has a placenta covering the internal os on transvaginal scans at 32 and 35 weeks. She had one small bleed that settled, and the scan shows no features of placenta accreta. What is the plan for delivery?
1. APlanned caesarean at 39-40 weeks
2. BInduction by amniotomy at 38 weeks
3. CPlanned caesarean at 36-37 weeks
4. DAwait spontaneous labour at term
Answer and explanation in LearnFree account
Question 15 · Easy
A 23-year-old primigravida at 28 weeks comes to casualty with a small painless bleed after intercourse. She is stable, the uterus is soft and the fetal heart is normal. Transvaginal ultrasound shows a fundal placenta well away from the lower segment. The bleeding has stopped. What is the next step to find the cause?
1. AImmediate induction of labour
2. BDigital examination to assess the cervix
3. CSpeculum examination of the cervix
4. DMRI of the pelvis
Answer and explanation in LearnFree account
Question 16 · Medium
During resuscitation of a 30-year-old with severe placental abruption and fetal death, blood oozes from her cannula sites. Platelets are 90,000/µL, prothrombin time 18 s (control 12 s) and fibrinogen 80 mg/dL (normal in late pregnancy above 300 mg/dL). Which blood component best corrects her main deficit?
1. APlatelet concentrate
2. BCryoprecipitate
3. CPacked red cells
4. DVitamin K injection
Answer and explanation in LearnFree account
Question 17 · Medium
A 27-year-old primigravida at 35 weeks is brought to a district hospital with abdominal pain and moderate dark vaginal bleeding. After 1 litre of crystalloid, pulse is 100/min and BP 112/72 mm Hg. The uterus is tender, and the CTG shows a baseline of 105/min with recurrent late decelerations. The cervix is 1 cm dilated and uneffaced. What is the next step?
1. ATocolysis with oral nifedipine
2. BAmniotomy and oxytocin infusion
3. CCorticosteroids, then delivery after 48 hours
4. DEmergency caesarean section
Answer and explanation in LearnFree account
Question 18 · Medium
During a planned caesarean for major placenta previa in a 31-year-old, the baby and placenta are delivered and the upper uterus contracts firmly with oxytocin, but brisk bleeding continues from the placental bed in the lower segment. What is the main reason for this bleeding?
1. AUterine inversion after delivery of the placenta
2. BRetained placental tissue in the upper segment
3. COxytocin has no effect on the uterus at caesarean
4. DLower segment has little muscle to close vessels
Answer and explanation in LearnFree account
Question 19 · Medium
A 29-year-old third gravida at 33 weeks is brought to casualty with vaginal bleeding. The medical officer lists four findings: 1. A tense, tender uterus. 2. Shock out of proportion to the visible blood loss. 3. A high presenting part with a breech presentation. 4. Absent or abnormal fetal heart sounds. Which findings favour abruptio placentae over placenta previa?
1. A1, 2 and 4 only
2. B2, 3 and 4 only
3. C1 and 2 only
4. D1, 2, 3 and 4
Answer and explanation in LearnFree account
Question 20 · Medium
A 32-year-old second gravida has vasa previa confirmed on transvaginal colour Doppler at 30 weeks. She has had no bleeding or contractions. What is the recommended plan for delivery?
1. ACaesarean once labour starts at term
2. BAmniotomy under scan guidance at 38 weeks
3. CInduction of labour at 37 weeks
4. DPlanned caesarean at about 34-36 weeks
Answer and explanation in LearnFree account
Question 21 · Hard
A 30-year-old second gravida at 34 weeks with placental abruption is in casualty. Her pads show about 200 mL of blood. Pulse is 130/min and BP 90/60 mm Hg. Using the shock index, which conclusion is correct?
1. ABlood loss is about 200 mL, as the pads show
2. BThe true blood loss far exceeds the visible loss
3. CHer shock is neurogenic from uterine distension
4. DTachycardia from pain and anxiety explains the vitals
Answer and explanation in LearnFree account
Question 22 · Hard
At her 20-week anomaly scan, a 26-year-old primigravida is found to have a placenta reaching the internal os. She has had no bleeding. The obstetrician counsels her with four statements: 1. Most placentas low at 20 weeks move away from the os by the third trimester. 2. A transvaginal scan is repeated at about 32 weeks. 3. If it still reaches the os at 32 weeks and she has no bleeding, it is scanned again at about 36 weeks to plan delivery. 4. Cervical cerclage is advised now to prevent bleeding. Which statements are correct?
1. A1, 2, 3 and 4
2. B1, 3 and 4 only
3. C1, 2 and 3 only
4. D2 and 3 only
Answer and explanation in LearnFree account
Question 23 · Easy
A 24-year-old Rh D-negative primigravida at 30 weeks is admitted with a small painless bleed from a low-lying placenta. Her husband is Rh D positive and her indirect Coombs test is negative. The bleeding has stopped and the fetus is well. What should be given in addition to observation?
1. AAnti-D immunoglobulin, with a Kleihauer test
2. BAnti-D immunoglobulin only after delivery
3. CNo anti-D, since the blood lost is maternal
4. DIntravenous immunoglobulin every week
Answer and explanation in LearnFree account
Question 24 · Easy
A 27-year-old second gravida has a transvaginal scan at 32 weeks for a low placenta seen at her anomaly scan. The lower edge of a posterior placenta now lies 15 mm from the internal os and does not cover it. What is the correct term under the current RCOG terminology?
1. APlacenta previa
2. BNormally sited placenta
3. CLow-lying placenta
4. DMarginal placenta previa
Answer and explanation in LearnFree account
Question 25 · Medium
A 33-year-old third gravida with two previous lower segment caesareans has an anterior placenta previa covering the os at her 28-week scan. She has had no bleeding. Which complication is most important to look for before planning her delivery?
1. APlacenta accreta spectrum
2. BPlacental chorioangioma
3. CCircumvallate placenta
4. DVasa previa
Answer and explanation in LearnFree account

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Antepartum haemorrhage: placenta previa, abruption, vasa previa

A 26-year-old second gravida at 29 weeks with known placenta previa is admitted with heavy painless bleeding that continues after 2 units of blood and 2 litres of fluid. Pulse is 130/min and BP 80/50 mm Hg; the fetal heart rate is 150/min. What is the next step?

A 25-year-old primigravida at 30 weeks is brought to casualty after falling from a two-wheeler. She has bruises over the abdomen but no bleeding or pain, the uterus is soft and the fetal heart rate is 146/min. Her vital signs are normal. What is the most appropriate next step for the pregnancy?

At her booking visit at an ANC clinic, a 31-year-old third gravida at 12 weeks asks whether she is at risk of bleeding from a low placenta later in pregnancy. Which item in her history most increases the risk of placenta previa?

A 30-year-old primigravida who conceived by IVF has her 20-week anomaly scan, which shows a low-lying placenta with a velamentous cord insertion. Which investigation should be done to look for vasa previa?

A 30-year-old second gravida with one previous vaginal birth has a placenta covering the internal os on transvaginal scans at 32 and 35 weeks. She had one small bleed that settled, and the scan shows no features of placenta accreta. What is the plan for delivery?

During a planned caesarean for major placenta previa in a 31-year-old, the baby and placenta are delivered and the upper uterus contracts firmly with oxytocin, but brisk bleeding continues from the placental bed in the lower segment. What is the main reason for this bleeding?

A 32-year-old second gravida has vasa previa confirmed on transvaginal colour Doppler at 30 weeks. She has had no bleeding or contractions. What is the recommended plan for delivery?

A 30-year-old second gravida at 34 weeks with placental abruption is in casualty. Her pads show about 200 mL of blood. Pulse is 130/min and BP 90/60 mm Hg. Using the shock index, which conclusion is correct?

A 24-year-old Rh D-negative primigravida at 30 weeks is admitted with a small painless bleed from a low-lying placenta. Her husband is Rh D positive and her indirect Coombs test is negative. The bleeding has stopped and the fetus is well. What should be given in addition to observation?

A 27-year-old second gravida has a transvaginal scan at 32 weeks for a low placenta seen at her anomaly scan. The lower edge of a posterior placenta now lies 15 mm from the internal os and does not cover it. What is the correct term under the current RCOG terminology?

A 33-year-old third gravida with two previous lower segment caesareans has an anterior placenta previa covering the os at her 28-week scan. She has had no bleeding. Which complication is most important to look for before planning her delivery?