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Question 105
Delivery suite → Haemorrhage
Classification
Question
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A woman at 37 weeks presents with approximately 800 mL of visible vaginal bleeding. Her pulse is 138 beats/min, blood pressure is 72/40 mmHg and she is confused. Which classification is most appropriate?
Question Stem
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Options
A
Minor haemorrhage because blood loss is below 1000 mL
B
Major haemorrhage because measured blood loss is 50–1000 mL
C
Spotting because the total blood loss cannot be accurately measured
D
Major haemorrhage unless haemoglobin is below 70 g/L
E
Massive haemorrhage because she has clinical shock
Explanation
Massive APH is defined not solely by measured blood loss but also by maternal clinical condition. RCOG defines massive haemorrhage as blood loss greater than 1000 mL and/or clinical shock. Therefore, an estimated loss of 800 mL accompanied by profound hypotension, tachycardia and altered consciousness constitutes massive haemorrhage. This illustrates why management must not depend solely on the externally measured volume of blood loss.
Option Validity
A) Clinical shock makes this massive haemorrhage despite blood loss below 1000 mL.
B) The presence of shock overrides classification based only on the measured volume.
C) This presentation clearly represents substantial haemorrhage rather than spotting.
D) Classification does not depend on reaching a particular haemoglobin threshold.
Further Reading
RCOG Green-top Guideline No. 63. Antepartum Haemorrhage. Royal College of Obstetricians and Gynaecologists; 2011.