EMQ

EMQ — Extended Matching Question · Review

Question 260

Delivery suite → Haemorrhage

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Type EEMQ

UUID 01314b90-27cc-4168-9785-fd1ae77564ea

Classification

Speciality

Obstetrics and Gynaecology

Group

Clinical

Title

Delivery suite

Topic

Haemorrhage

Subtopic 1

Antepartum haemorrhage

Subtopic 2

Placental abruption

Subtopic 3

Concealed haemorrhage

Question Type

EMQ

Question

EEMQ

Question Header

Question Stem

A 39-year-old G5P3 at 36+5 weeks presents with severe constant abdominal pain following a small dark vaginal bleed. She is pale, pulse 122/min and blood pressure 96/62 mmHg. The uterus is tense, tender and measures larger than expected. Only approximately 80 mL of vaginal blood has been observed. The fetal heart-rate trace is severely abnormal. A colleague considers the degree of maternal compromise disproportionate to the amount of haemorrhage.

Answer Bank

A The small visible loss excludes severe placental abruption

B Maternal shock is likely unrelated to the APH because less than 100 mL is visible

C The blood loss should be recorded as minor and no further estimation is necessary

D Severe abruption requires at least 1000 mL of external vaginal bleeding

E A tense uterus indicates placenta praevia rather than abruption

F Significant haemorrhage may be concealed behind the placenta, so visible vaginal loss can substantially underestimate the severity of abruption

G Concealed haemorrhage occurs only after fetal death

H A normal ultrasound would exclude concealed haemorrhage

Correct Answer

F. Significant haemorrhage may be concealed behind the placenta, so visible vaginal loss can substantially underestimate the severity of abruption

Explanation

Placental abruption may produce substantial concealed haemorrhage. Consequently, visible vaginal loss can markedly underestimate total blood loss. The maternal tachycardia, hypotension, pallor, tense tender uterus and severe fetal compromise indicate a serious event despite the small external loss. Clinical assessment must therefore account for concealed bleeding rather than classify severity solely by observed vaginal blood.

Option Validity

A) Small visible loss does not exclude severe abruption because bleeding may be concealed.

B) The maternal physiology is entirely compatible with substantial concealed obstetric haemorrhage.

C) Classification based solely on external loss would underestimate this presentation.

D) Severe clinical consequences can occur without one litre of visible vaginal blood.

E) A tense tender uterus is characteristic of abruption rather than typical placenta praevia.

G) Concealed bleeding can occur irrespective of whether fetal death has occurred.

H) Ultrasound has limited sensitivity for abruption and cannot reliably exclude concealed haemorrhage.

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Updated

2026-10-06 01:57:35

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