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Question 140
Delivery suite → Haemorrhage
Classification
Question
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A woman at 37 weeks has a major APH. Initial measured vaginal blood loss is 650 mL. After intravenous access and initial resuscitation, her pulse remains 132 beats/min, blood pressure is 82/46 mmHg and she becomes increasingly drowsy. Her haemoglobin is 118 g/L. Which parameter should most strongly determine escalation of haemorrhage management?
Question Stem
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Options
A
The measured blood loss remaining below 1000 mL
B
The absence of laboratory-confirmed anaemia
C
Her persistent physiological evidence of shock
D
Gestational age above 36 weeks
E
The haemoglobin concentration exceeding 100 g/L
Explanation
Acute obstetric haemorrhage must be assessed clinically rather than by measured blood loss or initial haemoglobin alone. RCOG defines massive haemorrhage as blood loss greater than 1000 mL and/or clinical shock. A woman with profound hypotension, tachycardia and altered consciousness therefore requires escalation as severe haemorrhage even when visible blood loss is less than 1000 mL. Furthermore, the initial haemoglobin may remain relatively normal in acute blood loss before redistribution and haemodilution occur.
Option Validity
A) Clinical shock can define massive haemorrhage even when measured external blood loss remains below 1000 mL.
B) Severe acute haemorrhage may be present before a substantial reduction in haemoglobin concentration becomes measurable.
D) Gestational age does not reduce the clinical significance of maternal cardiovascular shock.
E) An initially preserved haemoglobin concentration must not override clear physiological evidence of severe haemorrhage.
Further Reading
RCOG Green-top Guideline No. 63. Antepartum Haemorrhage. Royal College of Obstetricians and Gynaecologists; 2011.