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Question 173
Delivery suite → Haemorrhage
Classification
Question
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A woman at 35+5 weeks presents with suspected placental abruption. Approximately 300 mL vaginal blood loss is measured. Pulse is 118 beats/min and blood pressure 94/58 mmHg. Following initial fluid resuscitation, her blood pressure transiently improves to 108/64 mmHg but tachycardia persists. The uterus remains tense and tender and abdominal girth is increasing. Which interpretation should most strongly influence ongoing management?
Question Stem
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Options
A
Improvement in blood pressure confirms that the haemorrhage is controlled
B
The measured vaginal loss places an upper limit on the severity of haemorrhage
C
Increasing abdominal findings with persistent tachycardia suggest continuing concealed haemorrhage despite apparently improved blood pressure
D
Abruption becomes unlikely if external blood loss remains below 500 mL
E
Further resuscitation should await a fall in haemoglobin
Explanation
A transient improvement in blood pressure after fluid administration does not establish haemorrhage control. In placental abruption, substantial blood loss may remain concealed, and persistent tachycardia together with a tense tender uterus and increasing abdominal findings should raise concern for continuing internal haemorrhage. Management should be driven by serial maternal physiology and the entire clinical picture rather than a single improved observation or the measured vaginal loss. Acute haemoglobin may also initially underestimate blood loss.
Option Validity
A) Transient haemodynamic improvement following fluid does not prove that bleeding has stopped.
B) External blood loss can substantially underestimate total loss in abruption.
D) Clinically important abruption may occur with relatively little visible vaginal bleeding.
E) Haemoglobin may remain initially preserved and should not delay escalation for clinical haemorrhage.
Further Reading
RCOG Green-top Guideline No. 63. Antepartum Haemorrhage. Royal College of Obstetricians and Gynaecologists; 2011.