EMQ

EMQ — Extended Matching Question · Review

Question 258

Delivery suite → Haemorrhage

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Classification

Speciality

Obstetrics and Gynaecology

Group

Clinical

Title

Delivery suite

Topic

Haemorrhage

Subtopic 1

Antepartum haemorrhage

Subtopic 2

Placenta praevia

Subtopic 3

Digital vaginal examination

Question Type

EMQ

Question

EEMQ

Question Header

Question Stem

A 33-year-old G2P1 at 30+4 weeks presents to an emergency department with painless fresh vaginal bleeding. She is stable and the fetal heart is reassuring. Her anomaly-scan report is unavailable and she cannot recall where the placenta was situated. Abdominal examination shows a soft non-tender uterus and a high presenting part. A clinician proposes digital vaginal examination to determine whether cervical dilatation explains the bleeding.

Answer Bank

A Perform digital examination because maternal observations are normal

B Perform digital examination if the fetal heart rate remains reassuring

C Perform digital examination after giving anti-D

D Perform digital examination because a high presenting part excludes placenta praevia

E Perform digital examination provided the estimated blood loss is below 50 mL

F Perform digital examination because painless bleeding is more suggestive of labour than placenta praevia

G Perform digital examination after a normal full blood count

H Do not perform digital vaginal examination until placenta praevia has been excluded

Correct Answer

H. Do not perform digital vaginal examination until placenta praevia has been excluded

Explanation

When placenta praevia is possible, digital vaginal examination may precipitate severe haemorrhage and should not be performed until placental localisation has excluded praevia. The painless bleeding, soft uterus and high presenting part make this particularly important. Maternal stability, reassuring fetal assessment or small estimated blood loss do not remove the potential hazard.

Option Validity

A) Maternal stability does not make digital examination safe when placenta praevia remains possible.

B) Reassuring fetal status does not exclude placenta praevia.

C) Anti-D administration does not alter the mechanical risk of digital examination.

D) A high presenting part can be associated with placenta praevia rather than excluding it.

E) Small-volume bleeding does not eliminate the possibility of placenta praevia.

F) Painless APH is compatible with placenta praevia and does not justify digital examination.

G) A normal blood count does not exclude placenta praevia or make digital examination safe.

Source & metrics

Authored Difficulty

4.00

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Destination

eBook

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Updated

2026-10-06 01:57:35

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