EMQ

EMQ — Extended Matching Question · Review

Question 227

Delivery suite → Haemorrhage

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Type EEMQ

UUID 2057b1b9-63f4-44f6-851b-c283fff91692

Classification

Speciality

Obstetrics and Gynaecology

Group

Clinical

Title

Delivery suite

Topic

Haemorrhage

Subtopic 1

Antepartum haemorrhage

Subtopic 2

Placenta praevia

Subtopic 3

Investigation

Question Type

EMQ

Question

EEMQ

Question Header

Question Stem

A 39-year-old G5P3 at 33+6 weeks presents with approximately 120 mL of painless vaginal bleeding. She has had two previous caesarean births. Blood pressure is 118/72 mmHg, pulse 92/min and the abdomen is soft without uterine tenderness. The fetal heart-rate pattern is reassuring. Her booking documentation is available, but the report of placental position at the anomaly scan cannot be found. The bleeding has stopped following admission. The team needs to determine whether placenta praevia is responsible before deciding subsequent examination and management.

Answer Bank

A Ultrasound assessment of placental location

B Kleihauer test

C Coagulation screen

D Maternal serum alpha-fetoprotein

E CT abdomen and pelvis

F Abdominal radiography

G Digital vaginal examination

H Repeat maternal haemoglobin after four hours

Correct Answer

A. Ultrasound assessment of placental location

Explanation

The immediate diagnostic uncertainty is placental location. Ultrasound can establish whether placenta praevia is present and is therefore the appropriate investigation. Maternal blood tests may be required according to the severity of APH, but they do not establish placental position. This also illustrates an important distinction from placental abruption: ultrasound is useful for diagnosing placenta praevia, whereas a negative ultrasound cannot reliably exclude abruption.

Option Validity

B) Kleihauer testing evaluates fetomaternal haemorrhage rather than placental position.

C) A coagulation screen may be required in significant haemorrhage but cannot diagnose placenta praevia.

D) Maternal serum alpha-fetoprotein does not resolve placental localisation in acute APH.

E) CT is not the routine investigation for placental localisation in pregnancy.

F) Plain abdominal radiography cannot determine placental position.

G) Digital examination may be hazardous while placenta praevia remains possible.

H) Serial haemoglobin measurement may contribute to maternal assessment but does not establish the cause or placental location.

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Updated

2026-10-06 01:57:35

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