EMQ

EMQ — Extended Matching Question · Review

Question 246

Delivery suite → Haemorrhage

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Type EEMQ

UUID 8398dfe3-6ff4-4f1f-8fb0-cb294162621a

Classification

Speciality

Obstetrics and Gynaecology

Group

Clinical

Title

Delivery suite

Topic

Haemorrhage

Subtopic 1

Antepartum haemorrhage

Subtopic 2

Placental abruption

Subtopic 3

Diagnosis

Question Type

EMQ

Question

EEMQ

Question Header

Question Stem

A 34-year-old G3P2 at 35+6 weeks presents with sudden constant lower abdominal pain and a small amount of dark vaginal bleeding. She has pregnancy-induced hypertension. Her pulse is 108/min and blood pressure 138/88 mmHg. The uterus is firm and diffusely tender between contractions. The fetal heart-rate trace shows recurrent late decelerations. Ultrasound demonstrates a normally situated placenta without a visible retroplacental collection. A junior colleague argues that the absence of a sonographic haematoma makes placental abruption unlikely.

Answer Bank

A Placental abruption is excluded by the ultrasound findings

B Placental abruption remains a clinical diagnosis and a negative ultrasound does not exclude it

C Placenta praevia is the most likely diagnosis because vaginal bleeding is present

D The episode should be classified as unexplained APH until a retroplacental clot is demonstrated

E A normal maternal blood pressure excludes clinically significant abruption

F The diagnosis requires at least 500 mL of visible vaginal bleeding

G Cervical pathology should be assumed when ultrasound is negative

H Fetal compromise cannot be attributed to abruption without sonographic confirmation

Correct Answer

B. Placental abruption remains a clinical diagnosis and a negative ultrasound does not exclude it

Explanation

The combination of sudden abdominal pain, uterine tenderness and firmness, vaginal bleeding and fetal compromise is strongly suggestive of placental abruption. Ultrasound has limited sensitivity for abruption; failure to demonstrate a retroplacental collection therefore does not exclude the diagnosis. Clinical findings should outweigh falsely reassuring imaging when the presentation is characteristic.

Option Validity

A) Ultrasound has limited sensitivity for placental abruption and a negative scan cannot exclude it.

C) Placenta praevia more characteristically causes painless bleeding and does not explain the tense tender uterus.

D) A compelling clinical diagnosis should not be relabelled unexplained merely because ultrasound is negative.

E) Blood pressure may remain preserved despite clinically important haemorrhage.

F) Abruption may be severe despite relatively little visible bleeding because haemorrhage can be concealed.

G) Negative ultrasound for abruption does not establish a cervical source.

H) Fetal compromise is entirely compatible with significant placental separation despite negative imaging.

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4.00

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Updated

2026-10-06 01:57:35

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