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Question 134
Delivery suite → Haemorrhage
Classification
Question
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A woman at 31+5 weeks has approximately 30 mL of vaginal bleeding that has completely settled. She is haemodynamically stable, abdominal examination is normal and fetal assessment is reassuring. Her platelet count is subsequently normal. Which investigation set is most proportionate to the severity of this APH?
Question Stem
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Options
A
FBC and group and save
B
FBC, coagulation screen, four-unit cross-match, U&E and LFT
C
Coagulation screen and fibrinogen only
D
Four-unit cross-match without FBC
E
No maternal blood investigations because the bleeding has stopped
Explanation
Investigation should be proportionate to the severity of APH. For minor haemorrhage, RCOG recommends a full blood count and group and save. A coagulation screen is not routinely required in minor haemorrhage when the platelet count is normal. By contrast, major or massive haemorrhage requires broader investigation, including coagulation studies and cross-matching, with renal and liver biochemistry as appropriate. The distinction prevents both under-investigation of significant haemorrhage and unnecessary activation of major-haemorrhage investigations for a clinically minor episode.
Option Validity
B) This represents the broader investigation appropriate to major or massive haemorrhage rather than settled minor antepartum haemorrhage.
C) Isolated coagulation testing omits the appropriate full blood count and blood-group preparation.
D) Cross-matching four units of blood is disproportionate to this clinically minor, settled haemorrhage.
E) Minor antepartum haemorrhage still warrants appropriate maternal blood investigation.
Further Reading
RCOG Green-top Guideline No. 63. Antepartum Haemorrhage. Royal College of Obstetricians and Gynaecologists; 2011.