EMQ

EMQ — Extended Matching Question · Review

Question 249

Delivery suite → Haemorrhage

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Type EEMQ

UUID d5c530b1-16a7-400c-b77b-3ca711a88c28

Classification

Speciality

Obstetrics and Gynaecology

Group

Clinical

Title

Delivery suite

Topic

Haemorrhage

Subtopic 1

Antepartum haemorrhage

Subtopic 2

General

Subtopic 3

Investigation

Question Type

EMQ

Question

EEMQ

Question Header

Question Stem

A 25-year-old primigravida at 28+3 weeks presents with a single episode of approximately 20 mL painless vaginal bleeding. The bleeding has stopped. She feels well, pulse is 76/min, blood pressure 114/70 mmHg and the uterus is soft and non-tender. Fetal assessment is reassuring. Speculum examination identifies a small cervical ectropion with contact bleeding. There are no features of placental abruption or major haemorrhage. The team considers whether the extensive laboratory panel used for major APH is necessary.

Answer Bank

A Crossmatch four units and perform coagulation, renal and liver profiles in every APH regardless of severity

B No maternal blood testing can ever be appropriate in minor APH

C Perform coagulation studies because cervical ectropion predicts disseminated intravascular coagulation

D Perform serial haemoglobin every hour despite clinical stability

E Tailor investigations to the clinical severity; extensive major-haemorrhage testing is not automatically required for a minor, settled episode in a well woman

F Perform thrombophilia screening during the acute presentation

G Arrange CT angiography before discharge

H Delay all decisions until a Kleihauer result is available regardless of maternal rhesus status

Correct Answer

E. Tailor investigations to the clinical severity; extensive major-haemorrhage testing is not automatically required for a minor, settled episode in a well woman

Explanation

Investigation of APH should reflect the clinical severity and context. A stable woman with a very small, settled bleed and an identified benign local source does not automatically require the full laboratory and transfusion preparation appropriate to major or massive haemorrhage. This contrasts with significant APH, where full blood count, coagulation testing, crossmatching and biochemical assessment are appropriate. Rhesus status and the need for anti-D must still be considered separately.

Option Validity

A) The extensive investigation package for major haemorrhage should not be applied indiscriminately to every minor episode.

B) Some blood testing may still be appropriate depending on clinical circumstances, including rhesus considerations.

C) Cervical ectropion does not itself indicate consumptive coagulopathy.

D) Intensive serial testing is disproportionate in a clinically well woman with a minor settled bleed.

F) Acute universal thrombophilia screening is not the investigation required for this presentation.

G) CT angiography has no routine role in this minor settled APH.

H) Investigation should not be indiscriminately delayed pending a test that is relevant only in particular circumstances.

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Updated

2026-10-06 01:57:35

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