EMQ — Extended Matching Question · Review
Question 230
Delivery suite → Haemorrhage
Classification
Question
EEMQQuestion Header
Select the single most appropriate investigation to determine whether additional anti-D immunoglobulin is required.
Question Stem
A 28-year-old G2P1 at 30+3 weeks presents with a moderate episode of APH that has now settled. She is haemodynamically stable and fetal assessment is reassuring. Placental localisation does not demonstrate placenta praevia. Her blood group is O RhD negative and her antibody screen confirms that she is not sensitised. Anti-D immunoglobulin is being arranged. The obstetric team also needs to determine whether the volume of fetomaternal haemorrhage warrants an additional dose beyond the standard prophylactic amount.
Answer Bank
A
Full blood count
B
Coagulation screen
C
Liver function tests
D
Repeat ultrasound for placental localisation
E
Kleihauer test
F
Maternal haemoglobin electrophoresis
G
Cardiotocography
H
C-reactive protein
Correct Answer
E. Kleihauer test
Explanation
APH is a potentially sensitising event. A non-sensitised RhD-negative woman should receive anti-D immunoglobulin as appropriate, and assessment of fetomaternal haemorrhage is used where indicated to determine whether additional anti-D is required. The Kleihauer test estimates fetal red-cell transfer into the maternal circulation and therefore addresses the specific question of additional dosing.
Option Validity
A) Full blood count assesses maternal haematological status but does not quantify fetomaternal haemorrhage.
B) Coagulation testing assesses haemostasis rather than fetal red-cell transfer.
C) Liver function tests do not determine anti-D dose.
D) Placental localisation does not quantify fetomaternal haemorrhage.
F) Haemoglobin electrophoresis does not determine the magnitude of fetal red-cell transfer.
G) Cardiotocography assesses fetal wellbeing, not the required anti-D dose.
H) C-reactive protein has no role in determining anti-D requirements after APH.
Further Reading
RCOG Green-top Guideline No. 63. Antepartum Haemorrhage. Royal College of Obstetricians and Gynaecologists; 2011.