EMQ — Extended Matching Question · Review
Question 236
Delivery suite → Haemorrhage
Classification
Question
EEMQAnswer Bank
Correct Answer
Explanation
Bleeding beginning immediately after rupture of the membranes followed by sudden severe fetal compromise, while the mother remains haemodynamically well, should raise strong suspicion of ruptured vasa praevia. The crucial discriminator is the disproportion between the relatively preserved maternal condition and profound fetal deterioration. In APH associated with spontaneous or artificial rupture of the membranes, vasa praevia must be considered because the blood loss may be fetal rather than maternal.
Option Validity
A) Placental abruption more typically produces maternal abdominal pain, uterine tenderness or hypertonicity and maternal bleeding may be concealed.
B) Cervical ectropion may cause contact bleeding but does not explain abrupt profound fetal deterioration following membrane rupture.
C) Placenta praevia classically causes painless maternal bleeding but does not characteristically produce this membrane-rupture-associated pattern with disproportionate fetal collapse.
D) A normal bloody show should not cause profound persistent fetal bradycardia.
E) Uterine rupture usually occurs in a different clinical context and commonly produces maternal and abdominal features in addition to fetal compromise.
F) The temporal relationship to membrane rupture and disproportionate fetal compromise provides a specific diagnostic clue rather than supporting an unexplained classification.
H) Cervical malignancy may cause bleeding but does not explain the abrupt fetal deterioration immediately after membrane rupture.
Further Reading
RCOG Green-top Guideline No. 63. Antepartum Haemorrhage. Royal College of Obstetricians and Gynaecologists; 2011.