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Question 114
Delivery suite → Haemorrhage
Classification
Question
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A woman at 37 weeks presents with massive APH. She is shocked, with ongoing heavy bleeding while emergency resuscitation is commenced. Which approach to oxygen therapy is most appropriate in this setting?
Question Stem
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Options
A
A) Avoid oxygen because maternal hyperoxia may reduce uteroplacental perfusion
B
B) Give oxygen only after laboratory confirmation of anaemia
C
C) Delay oxygen until fetal monitoring has been established
D
D) Administer high-concentration oxygen as part of immediate resuscitation
E
E) Oxygen is indicated only if the fetus develops bradycardia
Explanation
Massive APH with maternal shock is a life-threatening emergency requiring immediate resuscitation according to airway, breathing and circulation principles. High-concentration oxygen forms part of the initial management of major haemorrhage while vascular access, blood sampling, fluid and blood-component replacement and definitive obstetric management are organised. Maternal resuscitation should not be delayed for laboratory investigations or fetal monitoring.
Option Validity
A) In maternal shock, correction of maternal hypoxia and optimisation of oxygen delivery take priority.
B) Oxygen therapy in shock does not depend on laboratory confirmation of anaemia.
C) Fetal monitoring must not delay maternal resuscitation.
E) The indication arises from maternal major haemorrhage and shock, not solely fetal bradycardia.
Further Reading
RCOG Green-top Guideline No. 63. Antepartum Haemorrhage. Royal College of Obstetricians and Gynaecologists; 2011.