EMQ

EMQ — Extended Matching Question · Review

Question 273

Delivery suite → Haemorrhage

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Classification

Speciality

Obstetrics and Gynaecology

Group

Clinical

Title

Delivery suite

Topic

Haemorrhage

Subtopic 1

Antepartum haemorrhage

Subtopic 2

Placental abruption

Subtopic 3

Fetal compromise delivery decision

Question Type

EMQ

Question

EEMQ

Question Header

Question Stem

A 32-year-old G2P1 at 35+5 weeks presents with sudden severe abdominal pain and a moderate dark vaginal bleed. She has chronic hypertension. Pulse is 108/min, blood pressure 128/78 mmHg and the uterus is tense and continuously tender. CTG demonstrates persistent fetal bradycardia at 80 beats/min with minimal variability. Ultrasound confirms a cephalic fetus and normally situated placenta but no retroplacental collection. Two large-bore intravenous cannulae are in place, blood has been taken and maternal resuscitative measures are underway. The cervix was 2 cm dilated at an examination performed after placenta praevia had been excluded.

Answer Bank

A Expedite delivery because the clinical picture is strongly suggestive of abruption with persistent fetal compromise, while continuing maternal resuscitation

B Await ultrasound demonstration of a retroplacental clot before deciding on delivery

C Observe for one hour because maternal blood pressure remains normal

D Commence prophylactic tocolysis to allow the fetal heart rate to recover

E Repeat haemoglobin before making a delivery decision

F Delay intervention until vaginal blood loss exceeds 1000 mL

G Discontinue fetal monitoring because the maternal condition is currently compensated

H Manage expectantly until spontaneous labour is established

Correct Answer

A. Expedite delivery because the clinical picture is strongly suggestive of abruption with persistent fetal compromise, while continuing maternal resuscitation

Explanation

The clinical picture is highly suggestive of placental abruption despite negative ultrasound, and persistent profound fetal bradycardia indicates severe fetal compromise. Maternal assessment and resuscitation must continue, but delivery should be expedited rather than delayed for imaging confirmation, laboratory deterioration or a larger visible blood loss. The key discrimination is simultaneous management of maternal haemorrhage risk and an immediately threatened fetus.

Option Validity

B) Ultrasound has insufficient sensitivity to exclude abruption and must not delay action in a compelling clinical presentation.

C) Preserved maternal blood pressure does not justify delay when persistent severe fetal compromise is present.

D) Tocolysis is inappropriate in this setting of suspected abruption and fetal compromise.

E) Acute haemoglobin may be misleading and should not delay necessary delivery.

F) Serious abruption may involve concealed bleeding and does not require one litre of visible loss before intervention.

G) Continuous fetal assessment is highly relevant when the fetus is alive and severely compromised.

H) Expectant management is inappropriate in the presence of persistent severe fetal compromise.

Source & metrics

Authored Difficulty

5.00

Evaluation Score

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Destination

eBook

Source

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Source Section

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Source Locator

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Updated

2026-10-06 01:57:35

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