EMQ

EMQ — Extended Matching Question · Review

Question 274

Delivery suite → Haemorrhage

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Type EEMQ

UUID 9630c75e-502a-4f2f-8f06-49c92e3ac92a

Classification

Speciality

Obstetrics and Gynaecology

Group

Clinical

Title

Delivery suite

Topic

Haemorrhage

Subtopic 1

Antepartum haemorrhage

Subtopic 2

Major haemorrhage

Subtopic 3

Resuscitation before fetal assessment

Question Type

EMQ

Question

EEMQ

Question Header

Question Stem

A 38-year-old G5P3 at 34+4 weeks arrives by ambulance following sudden heavy APH. She is drowsy, pulse 142/min, blood pressure 72/40 mmHg and peripheral perfusion is poor. Approximately 900 mL blood was seen by paramedics, with continuing loss. No fetal heart has yet been documented in the emergency room. One clinician wants to transfer her immediately for ultrasound to establish fetal viability before further management; another has started high-flow oxygen, large-bore intravenous access, urgent blood sampling and activation of the major haemorrhage response.

Answer Bank

A Transfer immediately for ultrasound before maternal intervention

B Establish fetal presentation before obtaining intravenous access

C Perform digital vaginal examination before commencing transfusion

D Delay resuscitation until fetal viability is established

E Obtain a formal CTG before assessing the maternal circulation

F Wait for haemoglobin and coagulation results before activating haemorrhage management

G Prioritise immediate maternal assessment and resuscitation; establish fetal status once maternal resuscitative assessment is underway

H Withhold blood products until the precise placental cause is identified

Correct Answer

G. Prioritise immediate maternal assessment and resuscitation; establish fetal status once maternal resuscitative assessment is underway

Explanation

This woman has life-threatening maternal haemorrhagic shock. Immediate maternal assessment and resuscitation take priority. Fetal status remains important and should be established promptly once maternal assessment and resuscitation are underway, but investigation of the fetus must not delay treatment of profound maternal circulatory compromise. This prioritisation is fundamental in severe APH.

Option Validity

A) Diagnostic imaging must not delay immediate treatment of profound maternal shock.

B) Fetal presentation is secondary to immediate maternal resuscitative priorities.

C) Digital examination is neither the first priority nor necessarily safe before placental location is known.

D) Maternal resuscitation cannot be deferred while fetal viability is determined.

E) CTG should not precede treatment of life-threatening maternal circulatory compromise.

F) Laboratory results support management but resuscitation must begin immediately.

H) Blood-product support in life-threatening haemorrhage must not await definitive aetiological diagnosis.

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5.00

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Updated

2026-10-06 01:57:35

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