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Question 178
Delivery suite → Haemorrhage
Classification
Question
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A woman at 38+4 weeks presents with suspected placental abruption. She has received red cells and plasma for major haemorrhage. Her blood pressure improves from 70/40 to 104/66 mmHg, but vaginal bleeding continues, the uterus remains tense and tender, and her pulse remains 126 beats/min. CTG shows persistent severe fetal compromise. Which interpretation of the apparent haemodynamic improvement is most appropriate?
Question Stem
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Options
A
Normalisation of blood pressure removes the indication for urgent delivery
B
Persistent tachycardia is expected after transfusion and can be disregarded
C
Delivery should be postponed until all laboratory parameters have normalised
D
A transient response to resuscitation does not constitute definitive control of an ongoing obstetric haemorrhage
E
Continued bleeding becomes clinically important only if hypotension recurs
Explanation
Resuscitation treats the physiological consequences of haemorrhage but does not necessarily remove its obstetric source. An improved blood pressure after blood-component replacement may represent a response to resuscitation rather than cessation of placental bleeding. Continuing haemorrhage, persistent tachycardia, uterine findings and severe fetal compromise indicate an ongoing emergency. Maternal resuscitation and definitive obstetric management should therefore proceed concurrently rather than allowing transient physiological improvement to delay delivery.
Option Validity
A) Improved blood pressure does not remove the indication created by continuing haemorrhage and severe fetal compromise.
B) Persistent tachycardia may indicate ongoing circulatory compromise and must be interpreted clinically.
C) Complete laboratory normalisation should not be awaited while the underlying haemorrhage continues.
E) Ongoing bleeding remains clinically important even before recurrent hypotension develops.
Further Reading
RCOG Green-top Guideline No. 63. Antepartum Haemorrhage. Royal College of Obstetricians and Gynaecologists; 2011.