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Question 104
Delivery suite → Haemorrhage
Classification
Question
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A woman at 35 weeks presents after an estimated 700 mL antepartum blood loss. She has no clinical signs of shock. How should this haemorrhage be classified?
Question Stem
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Options
A
Major haemorrhage
B
Spotting
C
Minor haemorrhage
D
Massive haemorrhage
E
Unclassifiable without a fall in haemoglobin
Explanation
RCOG classifies APH according to estimated blood loss and clinical condition. Minor haemorrhage is blood loss of less than 50 mL that has settled. Major haemorrhage is blood loss of 50–1000 mL without signs of clinical shock. Massive haemorrhage is blood loss greater than 1000 mL and/or associated with clinical shock. An estimated 700 mL loss without shock therefore meets the definition of major APH.
Option Validity
B) Spotting refers to staining, streaking or blood spotting rather than a 700 mL haemorrhage.
C) Minor haemorrhage is less than 50 mL and has settled.
D) 700 mL without shock does not meet the definition of massive haemorrhage.
E) Classification does not require a documented fall in haemoglobin.
Further Reading
RCOG Green-top Guideline No. 63. Antepartum Haemorrhage. Royal College of Obstetricians and Gynaecologists; 2011.