EMQ

EMQ — Extended Matching Question · Review

Question 242

Delivery suite → Haemorrhage

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Type EEMQ

UUID aae17d0c-5e25-4fd8-afc2-8ed03b0a09da

Classification

Speciality

Obstetrics and Gynaecology

Group

Clinical

Title

Delivery suite

Topic

Haemorrhage

Subtopic 1

Antepartum haemorrhage

Subtopic 2

Major haemorrhage

Subtopic 3

Coagulopathy

Question Type

EMQ

Question

EEMQ

Question Header

Question Stem

A 40-year-old G5P3 at 38 weeks develops a severe placental abruption. Initial resuscitation is underway and emergency delivery is being arranged. Although the measured vaginal loss is 450 mL, she remains tachycardic and blood continues to ooze from venepuncture sites. Repeat coagulation studies are markedly abnormal. A colleague suggests concentrating only on red-cell replacement because the visible haemorrhage has not reached one litre and assumes the coagulation abnormality will resolve spontaneously after delivery.

Answer Bank

A Coagulation abnormalities can be ignored until visible blood loss exceeds one litre

B Red-cell transfusion alone corrects all clinically important haemostatic abnormalities

C Coagulopathy is unlikely because the external blood loss is modest

D Delivery should be postponed until all coagulation results have normalised

E Abruption-associated coagulopathy is clinically irrelevant if blood pressure is maintained

F Repeat coagulation testing is unnecessary once the diagnosis of abruption is established

G Correct haemostatic abnormalities actively as part of ongoing major-haemorrhage management while treating the underlying obstetric cause

H The coagulation abnormality proves that the vaginal blood-loss estimate is inaccurate and no other assessment is required

Correct Answer

G. Correct haemostatic abnormalities actively as part of ongoing major-haemorrhage management while treating the underlying obstetric cause

Explanation

Placental abruption may be associated with significant coagulopathy, and the clinical severity may be substantially greater than the observed vaginal loss because haemorrhage can be concealed. Oozing from puncture sites and abnormal coagulation studies require active reassessment and correction of haemostatic abnormalities as part of major-haemorrhage management. This proceeds alongside resuscitation and definitive treatment of the obstetric cause rather than waiting for an arbitrary external blood-loss threshold.

Option Validity

A) Coagulopathy should be treated according to the clinical and laboratory picture, not an arbitrary visible-loss threshold.

B) Red cells replace oxygen-carrying capacity but do not by themselves correct all coagulation-factor deficits.

C) External loss may underestimate total haemorrhage, particularly in placental abruption.

D) Definitive obstetric treatment should not necessarily be delayed while awaiting complete laboratory normalisation.

E) Preserved blood pressure does not render significant coagulopathy harmless.

F) Serial assessment may be required in continuing major haemorrhage.

H) Abnormal coagulation contributes important information but does not replace comprehensive clinical assessment.

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Updated

2026-10-06 01:57:35

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