EMQ

EMQ — Extended Matching Question · Review

Question 235

Delivery suite → Haemorrhage

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Type EEMQ

UUID 5b268721-c7c4-4cba-9c41-e1216e2ffdd9

Classification

Speciality

Obstetrics and Gynaecology

Group

Clinical

Title

Delivery suite

Topic

Haemorrhage

Subtopic 1

Antepartum haemorrhage

Subtopic 2

Placental abruption

Subtopic 3

Diagnostic integration

Question Type

EMQ

Question

EEMQ

Question Header

Question Stem

A 38-year-old G4P2 at 35+5 weeks presents with sudden severe abdominal pain after noticing only a small amount of dark vaginal blood. She smokes and has pregnancy-induced hypertension. Pulse is 116/min and blood pressure 122/76 mmHg. The uterus is firm and diffusely tender. The fetal heart-rate trace shows recurrent late decelerations. Haemoglobin is 115 g/L. Ultrasound shows an appropriately grown fetus, no placenta praevia and no definite retroplacental haematoma. The radiology report states that there is no sonographic evidence of abruption. The team is considering whether another diagnosis should now be assumed.

Answer Bank

A Placental abruption remains the leading diagnosis despite limited external bleeding and the negative ultrasound

B Placental abruption is excluded because no retroplacental collection is demonstrated

C Placental abruption is excluded because the visible vaginal loss is small

D Preserved maternal blood pressure makes clinically significant abruption unlikely

E Placenta praevia is the most likely diagnosis because bleeding is present

F The episode should be labelled unexplained APH until maternal haemoglobin falls

G Vasa praevia should automatically replace abruption as the diagnosis whenever fetal compromise accompanies APH

H A cervical lesion should be assumed because ultrasound has not identified an abruption

Correct Answer

A. Placental abruption remains the leading diagnosis despite limited external bleeding and the negative ultrasound

Explanation

The integrated clinical picture strongly supports placental abruption: sudden abdominal pain, uterine tenderness and firmness, maternal tachycardia, recognised risk factors and fetal compromise. Limited external bleeding does not reassure because haemorrhage may be concealed. Preserved blood pressure and an initially normal haemoglobin do not exclude significant acute blood loss. Crucially, ultrasound has limited sensitivity for placental abruption, so failure to demonstrate a retroplacental haematoma must not override a compelling clinical diagnosis.

Option Validity

B) A negative ultrasound cannot reliably exclude placental abruption.

C) Concealed haemorrhage can produce severe abruption with little visible vaginal bleeding.

D) Maternal blood pressure may remain preserved during compensated haemorrhage.

E) The painful presentation with a firm tender uterus is much more consistent with abruption, and placenta praevia has been excluded on imaging.

F) Diagnosis should not be postponed until a fall in haemoglobin occurs.

G) Vasa praevia is particularly considered when bleeding is associated with membrane rupture and fetal compromise; fetal compromise alone does not supersede this strong abruption picture.

H) Failure to visualise an abruption does not establish a local cervical cause.

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Updated

2026-10-06 01:57:35

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