EMQ

EMQ — Extended Matching Question · Review

Question 284

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

Third stage PPH prevention

Question Type

EMQ

Question

EEMQ

Question Header

Question Stem

A 37-year-old G5P4 has a vaginal birth at 38+1 weeks. Her pregnancy was complicated by recurrent unexplained APH at 31, 33 and 35 weeks, but there was no bleeding during labour. The baby is well, maternal observations are stable and estimated intrapartum blood loss before placental delivery is minimal. She strongly prefers a physiological third stage because the current labour has been uncomplicated.

Answer Bank

A Physiological management because APH risk ends once the baby is born

B Routine manual removal of the placenta

C Recommend active management of the third stage because previous APH is associated with increased postpartum haemorrhage risk

D Avoid uterotonics because they may reproduce placental abruption

E Give fresh frozen plasma prophylactically before placental separation

F Perform hysterectomy prophylactically in women with recurrent APH

G Delay uterotonic therapy until excessive postpartum bleeding begins

H Manage the third stage according only to intrapartum blood loss

Correct Answer

C. Recommend active management of the third stage because previous APH is associated with increased postpartum haemorrhage risk

Explanation

A pregnancy complicated by APH carries an increased risk of postpartum haemorrhage. Active management of the third stage is therefore appropriate even when the bleeding resolved antenatally and labour itself has been uncomplicated. The preventive strategy reflects the downstream haemorrhagic risk rather than waiting for postpartum bleeding to develop.

Option Validity

A) The increased postpartum haemorrhage risk associated with APH does not disappear simply because the baby has been born.

B) APH does not justify routine manual removal of a normally separating placenta.

D) Appropriate uterotonic therapy is part of active third-stage management and is not avoided because of previous APH.

E) Prophylactic plasma is not indicated without haemorrhage or a relevant coagulation abnormality.

F) Recurrent APH is not an indication for prophylactic hysterectomy.

G) Preventive third-stage management should not be delayed until haemorrhage has already developed.

H) Antenatal APH history remains relevant even if intrapartum blood loss has been small.

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Updated

2026-10-06 01:57:35

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