EMQ

EMQ — Extended Matching Question · Review

Question 286

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

Evolving coagulopathy reassessment

Question Type

EMQ

Question

EEMQ

Question Header

Question Stem

A 35-year-old G3P2 at 37 weeks has a severe placental abruption with continuing haemorrhage. Initial haemoglobin is 112 g/L, platelets 174 × 10⁹/L and coagulation studies are within the laboratory reference range. Forty minutes later she remains tachycardic despite resuscitation, further blood loss has occurred and the uterus remains tense. A clinician argues that repeat coagulation studies are unnecessary because the initial results excluded consumptive coagulopathy.

Answer Bank

A Initial normal coagulation studies exclude subsequent DIC

B Repeat testing is needed only after delivery

C Platelet count alone is sufficient for subsequent assessment

D Repeat testing is unnecessary unless visible loss exceeds 2000 mL

E Coagulopathy can develop only after intrauterine fetal death

F A normal initial haemoglobin excludes clinically important continuing haemorrhage

G Laboratory reassessment should wait until maternal hypotension becomes refractory

H Continue serial clinical and laboratory reassessment because abruption-associated coagulopathy can evolve rapidly during ongoing haemorrhage

Correct Answer

H. Continue serial clinical and laboratory reassessment because abruption-associated coagulopathy can evolve rapidly during ongoing haemorrhage

Explanation

Severe placental abruption may be complicated by rapidly evolving consumptive coagulopathy. Initial normal results describe only the haemostatic state at the time of sampling and cannot guarantee continued stability during ongoing bleeding. Serial clinical and laboratory reassessment is therefore required and should inform blood-component therapy while resuscitation and definitive obstetric management proceed.

Option Validity

A) Normal initial results do not exclude subsequent consumptive deterioration.

B) Coagulation reassessment is important during active haemorrhage, not merely after birth.

C) Platelet count alone does not provide a complete assessment of haemostasis.

D) Coagulopathy is not dependent on an arbitrary external blood-loss threshold.

E) Abruption-associated coagulopathy may occur while the fetus remains alive.

F) Initial haemoglobin may remain relatively preserved during acute blood loss.

G) Reassessment should occur during evolving haemorrhage rather than waiting for refractory shock.

Source & metrics

Authored Difficulty

5.00

Evaluation Score

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Destination

eBook

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Updated

2026-10-06 01:57:35

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