EMQ

EMQ — Extended Matching Question · Review

Question 248

Delivery suite → Haemorrhage

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Classification

Speciality

Obstetrics and Gynaecology

Group

Clinical

Title

Delivery suite

Topic

Haemorrhage

Subtopic 1

Antepartum haemorrhage

Subtopic 2

General

Subtopic 3

Severity

Question Type

EMQ

Question

EEMQ

Question Header

Question Stem

A 36-year-old G4P2 at 34+5 weeks presents following an estimated 650 mL vaginal blood loss at home and continues to bleed on arrival. She is pale and clammy, pulse 124/min and blood pressure 94/58 mmHg. The uterus is soft and non-tender. Resuscitation is commenced immediately while the cause is investigated. A colleague asks how the episode should be categorised when documenting the severity of APH.

Answer Bank

A Major haemorrhage because blood loss is 50–1000 mL without shock, whereas the presence of shock makes the haemorrhage massive irrespective of the measured volume

B Minor haemorrhage because the measured loss remains below 1000 mL

C Spotting because the precise blood loss cannot be independently verified

D Recurrent APH because maternal compromise is present

E Unexplained APH until the anatomical cause is established

F Major haemorrhage only if four units of blood are transfused

G Massive haemorrhage only after measured blood loss exceeds 2000 mL

H Severity cannot be classified until the haemoglobin result is available

Correct Answer

A. Major haemorrhage because blood loss is 50–1000 mL without shock, whereas the presence of shock makes the haemorrhage massive irrespective of the measured volume

Explanation

RCOG classification incorporates both estimated blood loss and the maternal clinical condition. Major haemorrhage refers to blood loss of 50–1000 mL without signs of clinical shock, while massive haemorrhage is blood loss greater than 1000 mL and/or signs of clinical shock. Therefore physiological compromise must not be ignored merely because the measured external loss is below one litre. In practice this woman requires immediate management as severe haemorrhage.

Option Validity

B) Maternal shock prevents the episode being regarded as merely minor on the basis of measured volume.

C) This is substantially more than spotting and there is objective evidence of physiological compromise.

D) Recurrence describes temporal pattern rather than haemorrhage severity.

E) Aetiology and severity are separate dimensions; severity can be assessed before the cause is established.

F) Classification does not depend on the eventual number of red-cell units transfused.

G) Clinical shock is itself important even when measured loss has not exceeded an arbitrary higher threshold.

H) Acute haemorrhage severity is assessed clinically and should not await haemoglobin results.

Source & metrics

Authored Difficulty

4.00

Evaluation Score

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Destination

eBook

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Updated

2026-10-06 01:57:35

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