EMQ

EMQ — Extended Matching Question · Review

Question 259

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

Major haemorrhage

Subtopic 3

Initial haemoglobin interpretation

Question Type

EMQ

Question

EEMQ

Question Header

Question Stem

A 32-year-old G3P2 at 37+1 weeks presents after sudden heavy vaginal bleeding at home. She is pale, clammy and distressed, with pulse 126/min and blood pressure 92/56 mmHg. Ongoing bleeding is evident. Her admission haemoglobin is 121 g/L, similar to her antenatal value. A junior doctor suggests that major acute blood loss is unlikely because the haemoglobin has not fallen.

Answer Bank

A The normal haemoglobin excludes major haemorrhage

B Initial haemoglobin may not accurately reflect the magnitude of acute blood loss and must not override the clinical evidence of shock

C Haemorrhage is significant only after haemoglobin falls below 100 g/L

D Repeat haemoglobin in six hours before commencing resuscitation

E Diagnose anxiety-related tachycardia because haemoglobin is preserved

F Blood transfusion can never be considered while haemoglobin exceeds 100 g/L

G Estimate blood loss solely from the haemoglobin difference from booking

H A normal haemoglobin establishes that the bleeding is predominantly fetal

Correct Answer

B. Initial haemoglobin may not accurately reflect the magnitude of acute blood loss and must not override the clinical evidence of shock

Explanation

In acute haemorrhage the initial haemoglobin concentration may not immediately reflect the volume of blood lost. This woman has clear physiological evidence of major circulatory compromise and ongoing haemorrhage. Resuscitation and haemorrhage management must therefore be based on the clinical picture rather than delayed because the first haemoglobin appears normal.

Option Validity

A) A preserved initial haemoglobin does not exclude substantial acute blood loss.

C) Clinical severity is not defined by crossing a fixed haemoglobin threshold.

D) Resuscitation must not be delayed for serial laboratory confirmation in a shocked patient.

E) The combination of active bleeding, pallor, hypotension and tachycardia indicates haemorrhagic compromise.

F) Transfusion decisions in acute major haemorrhage are not determined solely by a single haemoglobin threshold.

G) Haemoglobin change cannot reliably quantify very recent acute blood loss.

H) Maternal haemoglobin does not establish whether the vaginal blood is fetal.

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4.00

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Updated

2026-10-06 01:57:35

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