EMQ — Extended Matching Question · Review
Question 232
Delivery suite → Haemorrhage
Classification
Question
EEMQQuestion Header
Select the single most appropriate interpretation and response.
Question Stem
A 32-year-old G2P1 at 34+2 weeks presents with recurrent APH. Approximately 250 mL of blood is seen on her clothing and pad. She is alert and speaking normally. Her blood pressure is 116/74 mmHg, but her pulse has risen from 84/min at booking to 122/min. She is cool peripherally and increasingly anxious. The uterus is tender and fetal monitoring is abnormal. Her initial haemoglobin is 119 g/L. A team member suggests that major resuscitative measures can wait because she is normotensive and her haemoglobin is normal.
Answer Bank
A
Normal blood pressure reliably excludes clinically important haemorrhage
B
Tachycardia should be disregarded until hypotension develops
C
The measured vaginal blood loss is the most reliable marker of severity
D
A normal initial haemoglobin excludes acute major blood loss
E
Fetal monitoring should replace maternal physiological assessment
F
Ultrasound findings should determine whether maternal resuscitation is required
G
The maternal tachycardia and clinical picture may represent compensated haemorrhage and require urgent reassessment and resuscitation
H
Active resuscitation is unnecessary until systolic blood pressure falls below 90 mmHg
Correct Answer
G. The maternal tachycardia and clinical picture may represent compensated haemorrhage and require urgent reassessment and resuscitation
Explanation
Significant obstetric haemorrhage may initially be compensated, with tachycardia and peripheral signs preceding hypotension. Visible vaginal loss can underestimate total blood loss, particularly when abruption is possible, and the initial haemoglobin may not reflect the acute loss. Maternal physiological assessment must therefore be interpreted as a whole. Waiting for hypotension or laboratory deterioration would risk delayed recognition and treatment.
Option Validity
A) Blood pressure can remain preserved during compensated haemorrhage.
B) Tachycardia may be an important early physiological marker of blood loss.
C) External blood loss may underestimate the true haemorrhage.
D) Initial haemoglobin may remain relatively preserved in acute bleeding.
E) Fetal assessment is important but cannot substitute for maternal physiological assessment.
F) Imaging does not determine whether a clinically deteriorating mother requires resuscitation.
H) Treatment should not be delayed until profound hypotension develops.
Further Reading
RCOG Green-top Guideline No. 63. Antepartum Haemorrhage. Royal College of Obstetricians and Gynaecologists; 2011.