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Question 196
Delivery suite → Haemorrhage
Classification
Question
SSBAQuestion Header
A woman at 32+6 weeks presents to a midwifery-led unit with 250 mL APH. Her pulse is 108 beats/min, blood pressure 104/66 mmHg and the fetal heart is present. Bleeding has slowed after initial assessment. The unit has no on-site blood bank, anaesthetic service or facility for emergency caesarean birth. Which management plan best reflects the guideline?
Question Stem
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Options
A
Keep her in the unit because bleeding has slowed and fetal heart activity is present
B
Transfer only if blood loss subsequently exceeds 1000 mL
C
Arrange outpatient review at the nearest obstetric unit within 24 hours
D
Assess and stabilise her as necessary, then transfer to a hospital maternity unit with resuscitation, transfusion, anaesthetic and emergency operative-delivery capability
E
Perform prolonged observation locally because transfer itself carries more risk than moderate APH
Explanation
The appropriate site of care depends not merely on the current blood-loss volume but on the facility's ability to respond to sudden deterioration. RCOG recommends that women with APH presenting to a midwifery-led unit, GP or emergency department should be assessed, stabilised where necessary and transferred to a hospital maternity unit capable of maternal resuscitation, blood transfusion, anaesthetic support and emergency operative delivery. APH can evolve rapidly, so apparent temporary stability does not compensate for absence of definitive emergency capability.
Option Validity
A) Temporary slowing of bleeding does not make a unit without emergency obstetric and transfusion facilities an appropriate definitive site of care.
B) Transfer should not depend on waiting for haemorrhage to become massive.
C) This presentation requires obstetric-unit assessment rather than delayed outpatient review.
E) Local observation cannot substitute for access to resuscitation, transfusion, anaesthesia and emergency operative delivery if deterioration occurs.
Further Reading
RCOG Green-top Guideline No. 63. Antepartum Haemorrhage. Royal College of Obstetricians and Gynaecologists; 2011.