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Question 107
Delivery suite → Haemorrhage
Classification
Question
SSBAQuestion Header
A woman at 36 weeks develops rapidly increasing antepartum haemorrhage with maternal cardiovascular compromise. Which approach to escalation is most appropriate?
Question Stem
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Options
A
The junior obstetrician should complete the diagnostic assessment before requesting senior assistance
B
Anaesthetic involvement is required only if caesarean section becomes necessary
C
Haematology should be contacted only after laboratory confirmation of coagulopathy
D
Management should remain within obstetrics until more than 1500 mL has been lost
E
Activate an immediate multidisciplinary response including senior obstetric and anaesthetic support
Explanation
Major or massive APH requires rapid multidisciplinary management. Senior obstetric and anaesthetic staff should be involved early, with appropriate activation of transfusion, laboratory and haematology support according to the severity of haemorrhage. Escalation should be driven by the clinical situation rather than waiting for an arbitrary measured blood-loss threshold or laboratory confirmation of coagulopathy. Delayed escalation can compromise both maternal resuscitation and timely delivery.
Option Validity
A) Senior assistance should be summoned early and should not await completion of diagnostic assessment.
B) Anaesthetic expertise is important for resuscitation as well as operative delivery.
C) Major haemorrhage may require early haematology and transfusion support before laboratory coagulopathy is confirmed.
D) Escalation is based on clinical severity and should not await a fixed blood-loss threshold.
Further Reading
RCOG Green-top Guideline No. 63. Antepartum Haemorrhage. Royal College of Obstetricians and Gynaecologists; 2011.