EMQ

EMQ — Extended Matching Question · Review

Question 255

Delivery suite → Haemorrhage

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Type EEMQ

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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

Assessment

Question Type

EMQ

Question

EEMQ

Question Header

Question Stem

A 31-year-old G3P2 at 36+4 weeks arrives with APH after describing a large pool of blood at home. Only a small amount is visible after admission. Pulse is 116/min, blood pressure 110/70 mmHg and she appears pale and anxious. Her initial haemoglobin is 118 g/L. The uterus is mildly tender and fetal monitoring is being established. The receiving clinician proposes documenting the haemorrhage as minor because the current pad contains little blood, the systolic pressure exceeds 100 mmHg and the haemoglobin is not anaemic.

Answer Bank

A Classify severity principally from the current sanitary-pad blood volume

B Use the initial haemoglobin as the most reliable measure of acute blood loss

C Regard preserved systolic blood pressure as excluding significant haemorrhage

D Ignore blood loss reported before arrival unless witnessed by clinical staff

E Determine severity from fetal heart-rate findings alone

F Wait for hypotension before escalating maternal care

G Assess the entire clinical picture, including reported and visible loss, maternal physiology and the possibility of concealed haemorrhage, rather than relying on one apparently reassuring measurement

H Use ultrasound estimation of blood volume as the definitive severity measure

Correct Answer

G. Assess the entire clinical picture, including reported and visible loss, maternal physiology and the possibility of concealed haemorrhage, rather than relying on one apparently reassuring measurement

Explanation

Assessment of APH severity requires integration of the history, estimated blood loss and maternal clinical condition. Visible loss after arrival may underestimate the total episode, particularly if substantial bleeding occurred before presentation or haemorrhage is concealed. Maternal tachycardia may precede hypotension, and initial haemoglobin may not reflect acute blood loss. No single reassuring measurement should therefore override the overall physiological and obstetric assessment.

Option Validity

A) Blood visible on a current pad may substantially underestimate the total haemorrhage.

B) Initial haemoglobin may remain relatively preserved despite acute significant blood loss.

C) Compensatory mechanisms may maintain blood pressure during clinically important haemorrhage.

D) A credible history of substantial bleeding before arrival is relevant to severity assessment.

E) Fetal findings are important but do not replace maternal haemorrhage assessment.

F) Escalation should not be delayed until overt hypotension develops.

H) Ultrasound cannot provide a definitive measurement of total maternal blood loss.

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4.00

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Updated

2026-10-06 01:57:35

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