EMQ

EMQ — Extended Matching Question · Review

Question 272

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

Maternal shock severity classification

Question Type

EMQ

Question

EEMQ

Question Header

Question Stem

A 35-year-old G3P2 at 36+2 weeks presents after an estimated 450 mL vaginal bleed. She is pale and confused, pulse 132/min, respiratory rate 26/min and blood pressure 84/48 mmHg. Bleeding continues slowly. Her uterus is tender and concealed placental abruption is suspected. A colleague argues that the episode cannot meet the most severe APH category because the measured external loss is below 1000 mL.

Answer Bank

A Minor haemorrhage because measured blood loss is below 500 mL

B Major haemorrhage without shock because external loss is below 1000 mL

C Unclassifiable until total blood loss exceeds 1000 mL

D Recurrent APH because shock is present

E Massive haemorrhage because clinical shock itself fulfils the severity criterion even when measured visible loss is below 1000 mL

F Spotting because concealed loss cannot be measured

G Moderate APH only because systolic pressure is measurable

H Severity cannot be classified before haemoglobin falls

Correct Answer

E. Massive haemorrhage because clinical shock itself fulfils the severity criterion even when measured visible loss is below 1000 mL

Explanation

RCOG severity classification incorporates maternal clinical condition as well as estimated blood loss. Massive haemorrhage is blood loss greater than 1000 mL and/or the presence of clinical shock. This woman has profound physiological compromise and possible concealed bleeding. The relatively modest measured external loss must therefore not lead to dangerous under-classification.

Option Validity

A) Clinical shock overrides classification based solely on the measured external volume.

B) Major haemorrhage in the 50–1000 mL range assumes absence of clinical shock.

C) More than 1000 mL measured loss is not required when clinical shock is already present.

D) Recurrence describes repeated episodes, not physiological severity.

F) Visible bleeding is more than spotting and concealed haemorrhage may increase the true loss.

G) A measurable blood pressure does not prevent the patient being in clinical shock.

H) Acute haemorrhage severity should not await a fall in haemoglobin.

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4.00

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Updated

2026-10-06 01:57:35

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