EMQ

EMQ — Extended Matching Question · Review

Question 229

Delivery suite → Haemorrhage

Review Question Previous Next

NextGen Workflow Status Needs Review

SQL status generated

Destination Site

Type EEMQ

UUID 0c487788-d3b8-4487-9dbe-54d90b6300eb

Classification

Speciality

Obstetrics and Gynaecology

Group

Clinical

Title

Delivery suite

Topic

Haemorrhage

Subtopic 1

Antepartum haemorrhage

Subtopic 2

Placental abruption

Subtopic 3

Assessment

Question Type

EMQ

Question

EEMQ

Question Header

Question Stem

A 36-year-old G4P2 at 37+1 weeks presents with sudden constant abdominal pain followed by approximately 80 mL of dark vaginal bleeding. She looks pale and distressed. Her pulse is 118/min and blood pressure 108/68 mmHg. The uterus feels tense and diffusely tender between contractions. The fetal heart rate is 170/min with recurrent decelerations. Her initial haemoglobin is 112 g/L. A colleague argues that the haemorrhage cannot be severe because the measured vaginal loss is small and the haemoglobin remains within the local reference range.

Answer Bank

A The small measured vaginal loss excludes major placental separation

B The initial haemoglobin demonstrates that clinically important haemorrhage has not occurred

C Concealed haemorrhage may make the true blood loss and severity substantially greater than the visible vaginal loss

D Placental abruption becomes clinically significant only after at least 500 mL of external bleeding

E Ultrasound should be used to quantify the concealed blood loss before resuscitation

F The fetal abnormalities are unlikely to be related to the maternal haemorrhage

G Concealed haemorrhage is characteristic of placenta praevia rather than abruption

H The preserved systolic blood pressure excludes significant haemorrhage

Correct Answer

C. Concealed haemorrhage may make the true blood loss and severity substantially greater than the visible vaginal loss

Explanation

This presentation is highly concerning for placental abruption with concealed haemorrhage. The volume of blood seen vaginally may substantially underestimate total blood loss. Maternal tachycardia, pallor, pain, uterine tenderness or hypertonicity and fetal compromise are therefore more informative than the measured external loss alone. Initial haemoglobin can also be misleading in acute haemorrhage. Clinical assessment should drive recognition and management rather than waiting for larger visible losses or laboratory deterioration.

Option Validity

A) Placental abruption may produce substantial concealed haemorrhage despite limited vaginal bleeding.

B) Initial haemoglobin may not accurately reflect the magnitude of acute blood loss.

D) Clinical severity is not defined by reaching a particular volume of visible bleeding.

E) Resuscitation must not be delayed while attempting to quantify concealed blood loss by imaging.

F) Placental separation and maternal haemorrhage may directly compromise fetal wellbeing.

G) Concealed haemorrhage is particularly important in placental abruption.

H) Compensatory mechanisms can preserve blood pressure despite significant haemorrhage.

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