EMQ

EMQ — Extended Matching Question · Review

Question 233

Delivery suite → Haemorrhage

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Type EEMQ

UUID 5e56f476-a495-4d8b-8fa2-6de8f11ef183

Classification

Speciality

Obstetrics and Gynaecology

Group

Clinical

Title

Delivery suite

Topic

Haemorrhage

Subtopic 1

Antepartum haemorrhage

Subtopic 2

General

Subtopic 3

Place of care

Question Type

EMQ

Question

EEMQ

Question Header

Question Stem

A 27-year-old primigravida at 32+4 weeks presents to a freestanding midwifery-led unit with sudden vaginal bleeding estimated at 300 mL. She feels faint on standing. Pulse is 112/min and blood pressure 102/64 mmHg. The fetal heart is present. The unit has no on-site blood bank, anaesthetic service or facility for emergency operative delivery. The nearest consultant-led maternity unit is 25 minutes away by ambulance. The bleeding is continuing while transfer arrangements are discussed.

Answer Bank

A Transfer immediately without initial treatment because definitive facilities are elsewhere

B Obtain a definitive ultrasound diagnosis before beginning treatment or transfer

C Observe locally until fetal compromise develops

D Begin assessment and stabilisation immediately, then transfer to a hospital maternity unit with appropriate emergency facilities

E Continue care in the midwifery-led unit if the visible bleeding subsequently stops

F Arrange routine outpatient obstetric review later the same day

G Delay transfer until all laboratory investigations have been completed

H Transfer only if ultrasound subsequently demonstrates placenta praevia

Correct Answer

D. Begin assessment and stabilisation immediately, then transfer to a hospital maternity unit with appropriate emergency facilities

Explanation

This woman has significant APH in a setting without the facilities required to manage sudden deterioration. Immediate maternal assessment and stabilisation should begin where she presents, followed by transfer to a hospital maternity unit capable of resuscitation, blood transfusion, anaesthesia and emergency operative delivery. Transfer should not be delayed for definitive diagnosis or completion of investigations, but neither should an unstable woman simply be dispatched without initial stabilisation.

Option Validity

A) Initial assessment and resuscitation should begin before and during arrangements for transfer.

B) Diagnostic imaging must not delay necessary stabilisation and escalation.

C) Maternal risk itself justifies escalation; fetal compromise need not first occur.

E) Temporary cessation of visible bleeding does not remove the need for appropriate facilities after significant APH.

F) Outpatient review is inappropriate for significant ongoing APH.

G) Completion of every investigation is not a prerequisite to transfer once immediate stabilisation has been undertaken.

H) Significant APH from several causes may require consultant-led hospital care.

Source & metrics

Authored Difficulty

4.00

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Updated

2026-10-06 01:57:35

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