EMQ

EMQ — Extended Matching Question · Review

Question 283

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

General

Subtopic 3

Resolved APH intrapartum monitoring

Question Type

EMQ

Question

EEMQ

Question Header

Question Stem

A 30-year-old G2P1 at 38+5 weeks is admitted in spontaneous labour. At 29 weeks she had a single minor unexplained APH that resolved completely; there has been no recurrent bleeding. Because the episode was unexplained, she subsequently received serial growth surveillance, which remained normal. On admission there is no vaginal bleeding, maternal observations are normal, the fetus is cephalic and the admission CTG is reassuring. During labour, however, a fresh vaginal bleed develops.

Answer Bank

A Continue the original low-risk monitoring plan because antenatal growth remained normal

B Stop fetal monitoring until the bleeding volume exceeds 500 mL

C Switch to maternal pulse monitoring alone

D Arrange ultrasound after delivery

E Continue intermittent auscultation because the admission CTG was normal

F Base surveillance solely on whether maternal blood pressure falls

G Escalate to continuous electronic fetal monitoring when active vaginal bleeding develops in labour

H Perform routine fetal blood sampling before interpreting the CTG

Correct Answer

G. Escalate to continuous electronic fetal monitoring when active vaginal bleeding develops in labour

Explanation

The key is the dynamic change in risk. A remote resolved episode does not necessarily define every later intrapartum decision, but new active vaginal bleeding during labour creates a current risk of fetal compromise. Fetal surveillance should therefore escalate to continuous electronic monitoring. Previous normal growth and a reassuring admission trace do not protect against an acute event developing later in labour.

Option Validity

A) New active bleeding changes the current intrapartum risk and should alter surveillance.

B) Fetal monitoring should not wait for an arbitrary large-volume haemorrhage threshold.

C) Maternal pulse monitoring cannot replace fetal heart rate surveillance.

D) Postnatal imaging would not address the immediate intrapartum fetal risk.

E) A reassuring admission CTG does not justify intermittent monitoring once active bleeding develops.

F) Fetal compromise may occur without maternal hypotension.

H) Fetal blood sampling is not a routine prerequisite for continuous electronic fetal monitoring.

Source & metrics

Authored Difficulty

5.00

Evaluation Score

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Destination

eBook

Source

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Updated

2026-10-06 01:57:35

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