EMQ — Extended Matching Question · Review
Question 215
Delivery suite → Haemorrhage
Classification
Question
EEMQAnswer Bank
Correct Answer
Explanation
The key discriminating features are the immediate onset of bleeding with artificial rupture of membranes, preserved maternal haemodynamic state and rapid profound fetal deterioration. This pattern should raise specific concern for ruptured vasa praevia because the blood loss may be fetal. The absence of uterine pain or hypertonicity makes abruption less compelling.
Option Validity
A) Placental abruption may cause fetal compromise but the immediate membrane-rupture relationship, soft uterus and preserved maternal condition favour vasa praevia.
B) Placenta praevia causes maternal haemorrhage and does not characteristically produce this disproportionate immediate fetal deterioration after amniotomy.
D) Cervical ectropion does not explain profound acute fetal deterioration.
E) Cervical malignancy does not explain bleeding beginning precisely with amniotomy and rapid fetal compromise.
F) Labour-related show does not cause this degree of acute fetal deterioration.
G) Vaginal trauma from examination or instrumentation would not adequately explain the disproportionate fetal deterioration.
H) The characteristic relationship to membrane rupture provides a specific diagnostic concern rather than unexplained APH.
Further Reading
RCOG Green-top Guideline No. 63. Antepartum Haemorrhage. Royal College of Obstetricians and Gynaecologists; 2011.