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Question 168
Delivery suite → Haemorrhage
Classification
Question
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A woman at 34+5 weeks presents with sudden severe abdominal pain and vaginal bleeding. Her uterus is tense and tender. Pulse is 142 beats/min, blood pressure 76/42 mmHg and she is confused. CTG demonstrates persistent fetal bradycardia. Ultrasound shows a normally situated placenta without a retroplacental collection. Her initial haemoglobin is 116 g/L. Which single finding should have the least influence on the immediate management strategy?
Question Stem
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Options
A
Persistent fetal bradycardia
B
Severe maternal hypotension with altered consciousness
C
Absence of a retroplacental collection on ultrasound
D
Tense tender uterus with continuing haemorrhage
E
Maternal tachycardia of 142 beats/min
Explanation
This woman has a compelling clinical presentation of severe placental abruption with maternal haemorrhagic shock and fetal compromise. Immediate maternal resuscitation and preparation for expedited delivery should proceed concurrently. The negative ultrasound should have the least influence because ultrasound has poor sensitivity for retroplacental clot and cannot exclude abruption. Likewise, the initially preserved haemoglobin must not provide false reassurance in acute blood loss. The maternal physiological abnormalities and persistent fetal bradycardia are direct indicators of severity and urgency.
Option Validity
A) Persistent fetal bradycardia represents severe fetal compromise and directly influences the urgency of delivery.
B) Profound hypotension and altered consciousness indicate severe maternal compromise requiring immediate resuscitation.
D) Uterine hypertonicity, tenderness and haemorrhage strongly support the clinical diagnosis of abruption.
E) Marked tachycardia is an important physiological indicator of maternal haemorrhagic compromise.
Further Reading
RCOG Green-top Guideline No. 63. Antepartum Haemorrhage. Royal College of Obstetricians and Gynaecologists; 2011.