EMQ

EMQ — Extended Matching Question · Review

Question 285

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

Major haemorrhage

Subtopic 3

Multidisciplinary escalation

Question Type

EMQ

Question

EEMQ

Question Header

Question Stem

A 39-year-old G4P3 at 36+6 weeks develops rapidly increasing APH. Her pulse rises from 105 to 138/min, blood pressure falls to 86/50 mmHg and she becomes pale and restless. The fetal heart trace is abnormal. Two large-bore cannulae have been inserted and initial resuscitation has commenced. The junior obstetric registrar proposes completing ultrasound and laboratory assessment before contacting the consultant obstetrician and anaesthetist because the precise cause of bleeding remains uncertain.

Answer Bank

A Complete all diagnostic investigations before requesting senior assistance

B Involve anaesthesia only if general anaesthesia becomes necessary

C Wait until measured blood loss exceeds 1500 mL

D Keep management within the obstetric team until coagulopathy is laboratory-confirmed

E Activate immediate senior multidisciplinary management, including obstetric and anaesthetic support, while resuscitation and assessment continue

F Wait for ultrasound confirmation of abruption before escalation

G Contact senior staff only after fetal death has been excluded

H Transfer the woman for imaging before activating haemorrhage management

Correct Answer

E. Activate immediate senior multidisciplinary management, including obstetric and anaesthetic support, while resuscitation and assessment continue

Explanation

Major APH with evolving maternal shock and fetal compromise requires immediate coordinated senior multidisciplinary management. Escalation should occur in parallel with resuscitation, investigation and planning for delivery. It must not be postponed until the precise aetiology, laboratory abnormalities or an arbitrary blood-loss threshold have been established.

Option Validity

A) Diagnostic completion must not delay senior multidisciplinary involvement in an unstable patient.

B) Anaesthetic expertise is relevant to resuscitation as well as to the eventual mode of anaesthesia.

C) Physiological deterioration requires escalation without waiting for a fixed measured blood-loss threshold.

D) Haemorrhage management should not remain isolated within obstetrics pending laboratory evidence of coagulopathy.

F) Ultrasound confirmation of abruption is neither sufficiently sensitive nor necessary before escalation.

G) Senior assistance is required because of current maternal and fetal compromise, regardless of final fetal outcome.

H) Transfer for imaging must not delay immediate haemorrhage management.

Source & metrics

Authored Difficulty

5.00

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Updated

2026-10-06 01:57:35

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