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Question 183
Delivery suite → Haemorrhage
Classification
Question
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A woman at 36+4 weeks has a major placental abruption. Following initial crystalloid and red-cell replacement, her blood pressure rises from 74/38 to 106/64 mmHg. However, her pulse remains 134 beats/min, she remains peripherally cool, vaginal bleeding continues and the uterus is tense. Which conclusion is most appropriate?
Question Stem
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Options
A
Restoration of systolic blood pressure above 100 mmHg confirms adequate resuscitation
B
Persistent tachycardia is expected in pregnancy and is therefore a poor marker of ongoing compromise
C
The response is incomplete and continuing haemorrhage should be assumed while resuscitation and definitive management proceed
D
Further blood-component therapy should depend exclusively on the next haemoglobin result
E
Delivery can safely be deferred until the pulse normalises spontaneously
Explanation
Resuscitation should be assessed from the complete physiological response rather than a single blood-pressure measurement. A transient improvement in blood pressure following volume replacement does not establish haemorrhage control when marked tachycardia, peripheral hypoperfusion, continued bleeding and clinical evidence of abruption persist. In addition, acute haemoglobin measurements may lag behind actual blood loss. Continuing maternal resuscitation, repeated assessment, appropriate blood-component replacement and definitive obstetric management should therefore proceed concurrently.
Option Validity
A) An isolated improvement in systolic blood pressure does not demonstrate restoration of adequate circulation or cessation of bleeding.
B) Marked persistent tachycardia in major APH is clinically significant and should not be dismissed as physiological pregnancy change.
D) Transfusion decisions in active major haemorrhage must integrate clinical condition and ongoing loss rather than haemoglobin alone.
E) Definitive management should not be delayed while evidence of ongoing haemorrhagic compromise persists.
Further Reading
RCOG Green-top Guideline No. 63. Antepartum Haemorrhage. Royal College of Obstetricians and Gynaecologists; 2011.