EMQ

EMQ — Extended Matching Question · Review

Question 253

Delivery suite → Haemorrhage

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Type EEMQ

UUID d24b3e46-4e7b-42c0-b0ac-b48f6a389e3b

Classification

Speciality

Obstetrics and Gynaecology

Group

Clinical

Title

Delivery suite

Topic

Haemorrhage

Subtopic 1

Antepartum haemorrhage

Subtopic 2

General

Subtopic 3

Intrapartum care

Question Type

EMQ

Question

EEMQ

Question Header

Question Stem

A 29-year-old G2P1 had two episodes of unexplained APH at 30 and 33 weeks. Placenta praevia was excluded, fetal growth remained appropriate and there has been no further bleeding. She presents in spontaneous labour at 39 weeks. Maternal observations are normal and the fetal heart-rate pattern is initially reassuring. Because the earlier bleeding has completely resolved, a trainee proposes that the previous APH can now be disregarded and that intrapartum care should be identical to that of an otherwise uncomplicated low-risk pregnancy.

Answer Bank

A Previous unexplained APH has no relevance once labour begins at term

B Intrapartum care should depend only on the current maternal haemoglobin

C Previous APH requires elective caesarean birth in every case

D Previous APH should remain part of the intrapartum risk assessment, with appropriate obstetric and fetal surveillance rather than automatically reverting to low-risk care

E Fetal assessment is unnecessary if there has been no bleeding for four weeks

F Previous APH is relevant only if placenta praevia was the cause

G Labour must be stopped with tocolysis because of the previous APH

H Previous APH requires prophylactic blood transfusion during labour

Correct Answer

D. Previous APH should remain part of the intrapartum risk assessment, with appropriate obstetric and fetal surveillance rather than automatically reverting to low-risk care

Explanation

A history of APH, including unexplained APH, remains relevant to subsequent pregnancy and intrapartum risk assessment. Resolution of bleeding does not necessarily return the pregnancy to an entirely low-risk pathway. Intrapartum planning should therefore take the previous haemorrhage and associated pregnancy risks into account and provide appropriate obstetric and fetal surveillance. This does not mean that every woman requires caesarean delivery or other intervention solely because APH occurred earlier.

Option Validity

A) Resolution of the acute episode does not make the earlier APH irrelevant to later risk assessment.

B) Maternal haemoglobin alone does not capture the obstetric and fetal implications of previous APH.

C) Previous APH does not itself mandate caesarean delivery in every woman.

E) Absence of recent bleeding does not automatically remove the need for appropriate fetal surveillance.

F) Unexplained APH can also influence subsequent pregnancy care.

G) Previous resolved APH is not an indication for routine tocolysis during term labour.

H) Prophylactic transfusion is not indicated solely because APH occurred earlier.

Source & metrics

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4.00

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Updated

2026-10-06 01:57:35

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