EMQ

EMQ — Extended Matching Question · Review

Question 226

Delivery suite → Haemorrhage

Review Question Previous Next

NextGen Workflow Status Needs Review

SQL status generated

Destination Site

Type EEMQ

UUID 8b7cdb63-20a3-4ba6-af18-f9ec2b965656

Classification

Speciality

Obstetrics and Gynaecology

Group

Clinical

Title

Delivery suite

Topic

Haemorrhage

Subtopic 1

Antepartum haemorrhage

Subtopic 2

Placenta praevia

Subtopic 3

Assessment

Question Type

EMQ

Question

EEMQ

Question Header

Question Stem

A 34-year-old G3P2 at 35+4 weeks presents with a second episode of painless bright-red vaginal bleeding. Her first pregnancy was delivered vaginally and her second by caesarean section. She is haemodynamically stable, the uterus is soft and non-tender, and the fetus is cephalic with a reassuring heart-rate pattern. Her anomaly scan documented a low-lying placenta, but no later placental localisation report is immediately available. The bleeding has now substantially settled. A junior doctor suggests performing a digital vaginal examination to determine whether the cervix is dilated.

Answer Bank

A Perform an immediate digital vaginal examination because the bleeding has settled

B Perform a rectal examination to assess cervical dilatation

C Perform a digital examination after confirming a reassuring fetal heart-rate pattern

D Perform a digital examination because the fetus is cephalic

E Perform a bimanual examination after intravenous access is established

F Defer all genital examination until after delivery

G Perform a digital examination if the haemoglobin concentration is normal

H Avoid digital vaginal examination until placenta praevia has been excluded where possible

Correct Answer

H. Avoid digital vaginal examination until placenta praevia has been excluded where possible

Explanation

The previous low-lying placenta, recurrent painless bleeding and soft non-tender uterus make placenta praevia an important possibility. A digital vaginal examination may precipitate severe haemorrhage if placenta praevia is present and should therefore be avoided until praevia has been excluded where possible. The reassuring fetal assessment, cephalic presentation and temporary cessation of bleeding do not remove this risk. A speculum examination may have a role when assessment for a local genital-tract source is required, but this is distinct from digital examination.

Option Validity

A) Cessation of visible bleeding does not exclude placenta praevia or make digital examination safe.

B) Rectal examination is not an appropriate substitute for digital vaginal examination in this situation.

C) A reassuring fetal heart-rate pattern does not establish placental location.

D) Cephalic presentation does not exclude placenta praevia.

E) Intravenous access does not remove the haemorrhagic risk of digital examination.

F) Appropriate genital assessment is not universally prohibited; the restriction particularly concerns digital examination before exclusion of praevia.

G) A normal haemoglobin concentration does not establish placental location or make digital examination safe.

Source & metrics

Authored Difficulty

4.00

Evaluation Score

—

Destination

Site

Source

—

Source Section

—

Source Locator

—

Updated

2026-10-06 01:57:35

Difficulty Factor

Not available yet

Attended Users

No candidate-attempt data yet