EMQ

EMQ — Extended Matching Question · Review

Question 288

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

Major haemorrhage

Subtopic 3

Blood loss estimation limitations

Question Type

EMQ

Question

EEMQ

Question Header

Question Stem

A 36-year-old G4P2 at 35+3 weeks presents with sudden abdominal pain and a small amount of dark vaginal bleeding. Only about 120 mL is visible on pads. She is pale, pulse 126/min and blood pressure 92/56 mmHg. The uterus is firm, tender and difficult to relax between contractions. CTG shows fetal tachycardia with recurrent decelerations. A colleague argues that the haemorrhage should be considered minor because the measured external loss is modest.

Answer Bank

A The measured external volume accurately defines total blood loss in suspected abruption

B A loss below 500 mL excludes major maternal haemorrhage

C Fetal compromise does not affect interpretation of maternal blood loss

D Concealed bleeding is clinically important only after fetal death

E Visible vaginal loss may substantially underestimate total haemorrhage, so maternal physiology and the complete clinical picture must determine severity

F Blood loss cannot be clinically significant while systolic pressure remains above 90 mmHg

G Ultrasound quantification is required before concealed bleeding can be considered

H Haemorrhage severity should be determined from haemoglobin alone

Correct Answer

E. Visible vaginal loss may substantially underestimate total haemorrhage, so maternal physiology and the complete clinical picture must determine severity

Explanation

In placental abruption, a substantial proportion of haemorrhage may be concealed behind the placenta or within the uterus. Visible loss can therefore markedly underestimate the true haemorrhage. The maternal tachycardia, hypotension, uterine findings and fetal compromise are incompatible with dismissing this episode as minor simply because little blood is visible. Clinical assessment must take precedence over a simplistic external-volume estimate.

Option Validity

A) External loss may substantially underestimate total haemorrhage in placental abruption.

B) A relatively small visible volume does not exclude major concealed bleeding.

C) Fetal compromise contributes important evidence about the severity and consequences of placental pathology.

D) Concealed haemorrhage can occur with a live fetus.

F) Significant haemorrhagic compromise can be present before profound hypotension develops.

G) Ultrasound is not required to recognise the clinical possibility of concealed abruption.

H) Acute haemoglobin values may initially fail to reflect the magnitude of blood loss.

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4.00

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Updated

2026-10-06 01:57:35

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