EMQ

EMQ — Extended Matching Question · Review

Question 250

Delivery suite → Haemorrhage

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Type EEMQ

UUID 730f36b0-55f4-445f-99d5-45e51803eb58

Classification

Speciality

Obstetrics and Gynaecology

Group

Clinical

Title

Delivery suite

Topic

Haemorrhage

Subtopic 1

Antepartum haemorrhage

Subtopic 2

Placenta praevia

Subtopic 3

Assessment

Question Type

EMQ

Question

EEMQ

Question Header

Question Stem

A 38-year-old G5P3 at 36 weeks presents with recurrent painless fresh vaginal bleeding. Ultrasound at 32 weeks demonstrated placenta praevia. She is haemodynamically stable. On abdominal examination the uterus is soft and non-tender. The fetus is in an oblique lie and the presenting part remains high. There are no regular contractions. A trainee suggests that the abnormal lie and high presenting part make placenta praevia less likely because neither finding directly measures placental position.

Answer Bank

A A high presenting part excludes placenta praevia

B Abnormal fetal lie strongly suggests placental abruption rather than praevia

C Abnormal lie and a high presenting part are clinically compatible with placenta praevia and reinforce the existing diagnostic context

D A soft uterus makes any placental cause of APH impossible

E Placenta praevia should cause a tense tender uterus

F Fetal presentation has no relevance whatsoever during assessment of APH

G The findings establish vasa praevia

H Digital vaginal examination is required to determine whether the placenta is obstructing the presenting part

Correct Answer

C. Abnormal lie and a high presenting part are clinically compatible with placenta praevia and reinforce the existing diagnostic context

Explanation

Placenta praevia may be associated with malpresentation or an abnormal lie and a high presenting part. In a woman with known placenta praevia and recurrent painless bleeding, these abdominal findings are therefore clinically coherent rather than contradictory. They do not replace ultrasound localisation, but they contribute to the integrated assessment and should not prompt hazardous digital examination.

Option Validity

A) A high presenting part is compatible with rather than exclusionary of placenta praevia.

B) Abnormal lie is recognised in association with placenta praevia and does not specifically indicate abruption.

D) A soft non-tender uterus is compatible with placenta praevia.

E) A tense tender uterus is more suggestive of placental abruption.

F) Fetal lie and presenting-part engagement can provide useful clinical context in suspected praevia.

G) These findings do not establish vasa praevia.

H) Digital vaginal examination may provoke haemorrhage and should not be used simply to clarify these findings before praevia is appropriately excluded.

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4.00

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Updated

2026-10-06 01:57:35

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