EMQ

EMQ — Extended Matching Question · Review

Question 287

Delivery suite → Haemorrhage

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Type EEMQ

UUID 8e7f779b-9eab-489e-8a10-e5447b561b36

Classification

Speciality

Obstetrics and Gynaecology

Group

Clinical

Title

Delivery suite

Topic

Haemorrhage

Subtopic 1

Antepartum haemorrhage

Subtopic 2

General

Subtopic 3

Unexplained APH consultant-led reclassification

Question Type

EMQ

Question

EEMQ

Question Header

Question Stem

A 26-year-old primigravida presents at 30+1 weeks with a clinically significant APH. Maternal observations are stable, placenta praevia is excluded, no local genital-tract cause is found and there are no convincing clinical features of abruption. CTG is reassuring and the bleeding settles. Her pregnancy had previously been classified as low risk and she had planned routine midwifery-led care. She asks whether, because no cause was identified, she can simply return to the original low-risk pathway without additional surveillance.

Answer Bank

A Return immediately to routine low-risk care because unexplained APH has no subsequent implications

B Continue midwifery-led care and arrange no further fetal growth assessment

C Deliver immediately because every unexplained APH requires preterm birth

D Reclassify the pregnancy as higher risk with consultant-led care and appropriate serial fetal growth surveillance

E Arrange surveillance only if a second APH occurs

F Perform weekly amniocentesis to assess placental function

G Use maternal haemoglobin alone to determine subsequent pregnancy risk

H Reclassify as high risk only if ultrasound later demonstrates placental abruption

Correct Answer

D. Reclassify the pregnancy as higher risk with consultant-led care and appropriate serial fetal growth surveillance

Explanation

Unexplained APH is associated with increased risks later in pregnancy, including adverse fetal growth and preterm birth. A woman whose pregnancy was previously considered low risk should therefore not simply return to the original pathway after a clinically significant unexplained APH. Subsequent care should reflect the changed risk profile, including consultant-led assessment and appropriate serial fetal growth surveillance.

Option Validity

A) Unexplained APH has recognised subsequent obstetric implications despite resolution of the acute episode.

B) The increased risk of fetal growth problems supports additional surveillance rather than no further assessment.

C) Unexplained APH does not automatically mandate immediate preterm delivery when maternal and fetal status are reassuring.

E) Additional care is relevant after the significant unexplained episode and need not await recurrence.

F) Amniocentesis is not a surveillance strategy for placental function after APH.

G) Maternal haemoglobin does not capture the subsequent fetal and obstetric risks associated with unexplained APH.

H) A negative ultrasound does not exclude abruption, and demonstration of abruption is not required before recognising the increased risk following unexplained APH.

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Updated

2026-10-06 01:57:35

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