EMQ

EMQ — Extended Matching Question · Review

Question 265

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

Crossmatch and coagulation testing

Question Type

EMQ

Question

EEMQ

Question Header

Question Stem

A 37-year-old G4P2 at 38 weeks presents with continuing heavy APH. Approximately 800 mL of external blood loss is estimated, but the uterus is tender and concealed abruption is suspected. Pulse is 118/min, blood pressure 102/64 mmHg and the fetal heart-rate trace is abnormal. Two wide-bore intravenous cannulae have been inserted and active resuscitation is underway. The team must select the appropriate initial laboratory investigation and blood-preparation package.

Answer Bank

A Full blood count only; add other tests if haemoglobin is below 100 g/L

B Group and save only because blood loss is below one litre

C Kleihauer test alone before any other blood investigations

D Liver function tests alone because abruption primarily causes hepatic coagulopathy

E Coagulation screen only; crossmatching is unnecessary until shock develops

F Serial haemoglobin measurements without immediate blood-bank preparation

G Full blood count, coagulation screen, crossmatch four units of blood, and renal and liver function assessment

H Thrombophilia screen and fibrinogen only, with no crossmatch unless operative delivery is confirmed

Correct Answer

G. Full blood count, coagulation screen, crossmatch four units of blood, and renal and liver function assessment

Explanation

Major or severe APH requires prompt investigation alongside resuscitation. Appropriate initial testing includes full blood count and coagulation assessment, with crossmatching of blood because transfusion may be required. Renal and liver function should also be assessed in significant haemorrhage. Investigation must proceed in parallel with, rather than delay, active maternal resuscitation and management of the underlying obstetric cause.

Option Validity

A) Full blood count alone is insufficient in significant ongoing APH.

B) Group and save provides inadequate preparation when major haemorrhage and transfusion are realistic possibilities.

C) Fetomaternal haemorrhage testing does not replace the core maternal haemorrhage investigations.

D) Liver function assessment alone omits essential haematological, coagulation and transfusion preparation.

E) Significant APH warrants blood-bank preparation before overt shock necessarily develops.

F) Serial haemoglobin alone neither assesses coagulopathy nor prepares appropriately for transfusion.

H) Routine thrombophilia screening is not the acute investigation package required for major APH.

Source & metrics

Authored Difficulty

4.00

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Updated

2026-10-06 01:57:35

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