EMQ

EMQ — Extended Matching Question · Review

Question 256

Delivery suite → Haemorrhage

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Type EEMQ

UUID 03272908-fcbf-427d-a368-824b514ecd9e

Classification

Speciality

Obstetrics and Gynaecology

Group

Clinical

Title

Delivery suite

Topic

Haemorrhage

Subtopic 1

Antepartum haemorrhage

Subtopic 2

Placental abruption

Subtopic 3

Ultrasound diagnosis

Question Type

EMQ

Question

EEMQ

Question Header

Question Stem

A 36-year-old G3P1 at 35+2 weeks presents with abrupt-onset constant abdominal pain and a moderate vaginal bleed. She has chronic hypertension. Her pulse is 112/min and the uterus is firm and markedly tender. CTG demonstrates recurrent late decelerations. Ultrasound confirms a normally situated placenta and reports no retroplacental haematoma. The registrar proposes abandoning placental abruption as the working diagnosis because imaging has not demonstrated placental separation.

Answer Bank

A Repeat ultrasound until a retroplacental haematoma is demonstrated before treating abruption

B Reclassify the episode as unexplained APH because ultrasound is negative

C Diagnose placenta praevia despite normal placental localisation

D Await a fall in haemoglobin before reconsidering placental abruption

E Continue to treat placental abruption as a clinical diagnosis because ultrasound does not exclude it

F Perform digital vaginal examination to establish the cause

G Diagnose labour because uterine pain is present

H Discharge if repeat ultrasound remains negative

Correct Answer

E. Continue to treat placental abruption as a clinical diagnosis because ultrasound does not exclude it

Explanation

Placental abruption is principally a clinical diagnosis. Ultrasound may demonstrate a retroplacental clot, but its sensitivity is insufficient to exclude abruption when imaging is negative. This woman has a highly coherent clinical picture: sudden pain, bleeding, uterine tenderness and firmness, maternal tachycardia and fetal compromise in the presence of hypertension. Management must therefore be driven by the clinical condition rather than falsely reassuring imaging.

Option Validity

A) Demonstration of a retroplacental haematoma is not required before acting on a convincing clinical diagnosis.

B) Negative ultrasound does not convert a clinically convincing abruption into unexplained APH.

C) Normal placental localisation argues against placenta praevia.

D) Acute haemoglobin may initially remain relatively preserved and should not determine whether abruption is considered.

F) Digital examination is not the investigation required to confirm abruption.

G) Labour alone does not adequately explain this combination of constant pain, uterine tenderness and fetal compromise.

H) A negative ultrasound cannot justify discharge when the maternal and fetal clinical picture suggests abruption.

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4.00

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Updated

2026-10-06 01:57:35

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