Which one of the following parameters precisely defines grade 3 abruptio placentae?
Intrauterine fetal death
Grade 3 abruptio placentae is precisely defined by intrauterine fetal death. In the Page (Sher) classification: grade 0 is asymptomatic, found retrospectively as a retroplacental clot; grade 1 has slight bleeding, mild uterine irritability, normal BP and fibrinogen, no fetal distress; grade 2 has moderate bleeding, a tender tetanic uterus, maternal tachycardia, fibrinogen 150 to 250 mg/dL and a live but distressed fetus; grade 3 has fetal death, heavy or concealed bleeding, board-like uterus, maternal shock and fibrinogen less than 150 mg/dL, subdivided into 3a without and 3b with coagulopathy.
Why the others are wrong: Moderate vaginal bleeding belongs to grade 2, and since up to 20 percent of abruptions are concealed, visible loss can never define a grade. Maternal tachycardia already appears in grade 2 and is a non-specific sign of hypovolaemia. Low fibrinogen occurs in only about 30 percent of grade 3 cases (grade 3b) and is absent in 3a, so it is not the defining criterion.
Key point: Grade 3 equals fetal death; coagulopathy merely splits it into 3a and 3b. Concealed haemorrhage means visible bleeding always understates severity.
Important Questions from Complications during pregnancy
- Which one of the following is NOT a risk factor for the development of placenta previa?
- Common clinical presentations of moderate to severe abruption are all EXCEPT:
- Which of the following is NOT the hormonal basis for hyperemesis gravidarum?
- Consider the following statements regarding pregnancy with Rh isoimmunization:
1. Indirect coombs test is performed in mother
2. Methergin is withheld at delivery of anterior shoulder
3. Middle cerebral artery peak systolic velocity is an accurate method to predict fetal anemia
Which of the statements given above are correct? - In fetus with Spina bifida, which of the following sign/signs may be seen on ultrasound?
