EMQ — Extended Matching Question · Review
Question 270
Delivery suite → Haemorrhage
Classification
Question
EEMQQuestion Header
Select the single most appropriate classification of the bleeding episode.
Question Stem
A 31-year-old G2P0 presents at 23+6 weeks with fresh vaginal bleeding. Ultrasound confirms a live fetus and a normally situated placenta. The bleeding settles. Twelve hours later, now at 24+0 weeks, she has a further episode of vaginal bleeding of similar volume. The team is documenting the episodes according to the gestational definition used in the RCOG antepartum haemorrhage guideline.
Answer Bank
A
Both episodes are APH because fetal viability was demonstrated
B
The episode from 24+0 weeks falls within the guideline definition of APH, whereas bleeding before 24+0 weeks does not
C
Neither episode is APH until 28+0 weeks
D
Both episodes are APH because the pregnancy is in the second trimester
E
Only bleeding after 37 weeks is classified as APH
F
APH begins at 20+0 weeks
G
Classification depends on estimated blood loss rather than gestation
H
APH applies only after the onset of labour
Correct Answer
B. The episode from 24+0 weeks falls within the guideline definition of APH, whereas bleeding before 24+0 weeks does not
Explanation
RCOG Green-top Guideline No. 63 defines antepartum haemorrhage as bleeding from or into the genital tract occurring from 24+0 weeks of pregnancy and before birth. The two otherwise similar episodes therefore fall on opposite sides of the gestational threshold. The definition is determined by timing, not fetal viability, bleeding volume or onset of labour.
Option Validity
A) Demonstrated fetal viability does not replace the specified 24+0-week threshold.
C) The definition begins at 24+0 weeks, not 28 weeks.
D) Second-trimester status alone does not define APH.
E) APH is not restricted to term pregnancy.
F) The definition uses 24+0 weeks rather than 20+0 weeks.
G) Blood-loss volume affects severity assessment but not the gestational definition of APH.
H) APH occurs before birth and is not restricted to bleeding after labour begins.
Further Reading
RCOG Green-top Guideline No. 63. Antepartum Haemorrhage. Royal College of Obstetricians and Gynaecologists; 2011.