EMQ

EMQ — Extended Matching Question · Review

Question 257

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

Speculum examination

Question Type

EMQ

Question

EEMQ

Question Header

Question Stem

A 29-year-old primigravida at 31+6 weeks presents with recurrent small-volume fresh vaginal bleeding, particularly after intercourse. She is haemodynamically stable, has no abdominal pain and the uterus is soft and non-tender. Fetal assessment is reassuring. Her 20-week scan documented a posterior placenta clear of the cervical os. No obvious cause for the bleeding has yet been identified. The team wishes to assess for a lower-genital-tract source.

Answer Bank

A Perform immediate digital cervical examination as the first examination

B Avoid all genital examination until delivery

C Perform a speculum examination to assess the cervix and vagina for a local cause of bleeding

D Diagnose placental abruption from the recurrent nature of the bleeding

E Perform rectal examination to assess cervical dilatation

F Arrange emergency caesarean birth without further assessment

G Use ultrasound alone because it reliably identifies cervical lesions

H Assume the bleeding is physiological because it follows intercourse

Correct Answer

C. Perform a speculum examination to assess the cervix and vagina for a local cause of bleeding

Explanation

Speculum examination can be useful in APH to identify a lower-genital-tract source, particularly when cervical or vaginal pathology is suspected. This woman is stable, placenta praevia has previously been excluded by placental localisation, and the history of postcoital bleeding makes cervical pathology particularly relevant. Speculum examination is distinct from digital vaginal examination, which carries specific concern when placenta praevia has not been excluded.

Option Validity

A) Digital examination is not the preferred initial method for identifying a local cervical or vaginal bleeding source.

B) Genital examination is not universally contraindicated; appropriately selected speculum examination may identify the cause.

D) Recurrent bleeding alone does not diagnose placental abruption.

E) Rectal examination is not the appropriate investigation for a suspected cervical or vaginal source.

F) There is no indication for immediate operative delivery in this stable presentation.

G) Ultrasound does not replace direct assessment of suspected cervical or vaginal pathology.

H) Postcoital bleeding should not automatically be dismissed as physiological in a woman presenting with APH.

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Updated

2026-10-06 01:57:35

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