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Q1: Clinical features (2 min)
"How does placenta praevia present?"
- PAINLESS, causeless, RECURRENT bright red bleeding after 20 weeks
- Uterus SOFT and NON-TENDER
- Fetal heart usually normal
- Abnormal lie (transverse, breech)
- First bleed = minor "warning bleed", subsequent = heavier
Q2: Diagnosis (2 min)
"How do you investigate suspected praevia?"
- Transvaginal ultrasound = GOLD STANDARD (safe, accurate)
- NEVER digital vaginal exam (unless in theatre — "double setup")
- MRI for suspected accreta (depth of invasion)
- FBC, Group and Save
- Anti-D if Rh negative
Q3: Management (3 min)
"How do you manage placenta praevia?"
- Stable preterm: admit, observe, corticosteroids, plan C-section at 37 to 38 weeks
- Heavy bleeding: resuscitate, emergency C-section
- Major praevia: elective C-section at 37 to 38 weeks
- Minor/low-lying (edge over 2cm from os): may attempt vaginal delivery
- Anti-D for Rh-negative
- Check for accreta (previous C-section + praevia)
Q4: Praevia vs abruption (2 min)
"How do you distinguish praevia from abruption?"
- Praevia: PAINLESS, bright red, soft uterus, normal FH
- Abruption: PAINFUL, dark/concealed, hard/woody/tender uterus, fetal distress
- Praevia: recurrent episodes, abnormal lie, no pre-eclampsia
- Abruption: sudden, associated with pre-eclampsia, may have DIC