EMQ

EMQ — Extended Matching Question · Review

Question 252

Delivery suite → Haemorrhage

Review Question Previous Next

NextGen Workflow Status Needs Review

SQL status generated

Destination Site

Type EEMQ

UUID 82a93830-d60b-4e85-97bf-041519f5cddc

Classification

Speciality

Obstetrics and Gynaecology

Group

Clinical

Title

Delivery suite

Topic

Haemorrhage

Subtopic 1

Antepartum haemorrhage

Subtopic 2

Placental abruption

Subtopic 3

Risk assessment

Question Type

EMQ

Question

EEMQ

Question Header

Question Stem

A 33-year-old G4P2 at 34+1 weeks presents with painful vaginal bleeding and a tender uterus. Her blood pressure is 146/92 mmHg and the fetal heart-rate trace is abnormal. During confidential history-taking she reports cigarette smoking and intermittent recreational cocaine use, including use the previous evening. A colleague considers the drug history incidental because the patient has several other recognised risk factors for placental abruption.

Answer Bank

A Cocaine exposure is unrelated to placental abruption

B Cocaine or amphetamine use is a recognised risk factor for placental abruption and is clinically relevant to this presentation

C Only cigarette smoking is relevant; stimulant drugs are not associated with abruption

D Recreational drug exposure is relevant only if maternal hypotension develops

E Cocaine use specifically predicts placenta praevia rather than abruption

F Drug exposure should be considered only after ultrasound demonstrates a retroplacental clot

G Substance use cannot alter the obstetric differential diagnosis after 24 weeks

H Cocaine exposure is relevant only to fetal growth and not acute placental separation

Correct Answer

B. Cocaine or amphetamine use is a recognised risk factor for placental abruption and is clinically relevant to this presentation

Explanation

Cocaine and amphetamine use are recognised risk factors for placental abruption. In this patient the stimulant exposure is therefore clinically relevant alongside smoking and hypertension, particularly given the painful bleeding, uterine tenderness and fetal compromise. Risk factors do not establish the diagnosis by themselves, but they appropriately modify diagnostic probability when integrated with the clinical presentation.

Option Validity

A) Cocaine is a recognised risk factor for placental abruption.

C) Smoking is relevant, but stimulant drugs are also recognised risk factors.

D) Maternal hypotension is not required for stimulant exposure to be clinically relevant.

E) Cocaine use is associated with abruption rather than specifically predicting placenta praevia.

F) Clinical risk assessment does not depend on sonographic demonstration of a retroplacental clot.

G) Substance-use history remains clinically relevant to the differential diagnosis of APH.

H) Stimulant exposure has relevance to acute placental abruption, not solely fetal growth.

Source & metrics

Authored Difficulty

4.00

Evaluation Score

—

Destination

Site

Source

—

Source Section

—

Source Locator

—

Updated

2026-10-06 01:57:35

Difficulty Factor

Not available yet

Attended Users

No candidate-attempt data yet