EMQ

EMQ — Extended Matching Question · Review

Question 289

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

Placental abruption

Subtopic 3

Clinical diagnosis despite negative ultrasound

Question Type

EMQ

Question

EEMQ

Question Header

Question Stem

A 33-year-old G2P1 at 34+6 weeks presents with sudden constant abdominal pain, vaginal bleeding and reduced fetal movements. She has pre-eclampsia. The uterus is tense and diffusely tender. CTG demonstrates fetal tachycardia with recurrent late decelerations. Ultrasound shows a normally situated placenta and does not demonstrate a retroplacental haematoma. Maternal observations are currently stable.

Answer Bank

A Placental abruption remains a clinical diagnosis and a negative ultrasound does not exclude it

B Placental abruption is excluded because no retroplacental clot is visible

C Placenta praevia is the most likely diagnosis because ultrasound is negative for abruption

D The diagnosis should be deferred until haemoglobin falls

E Abruption can be diagnosed only after delivery by placental inspection

F Normal maternal blood pressure excludes significant abruption

G CTG abnormalities should be ignored when placental imaging is normal

H MRI is required before clinical management can proceed

Correct Answer

A. Placental abruption remains a clinical diagnosis and a negative ultrasound does not exclude it

Explanation

Placental abruption is principally a clinical diagnosis. Ultrasound may identify a retroplacental haematoma but has limited sensitivity and cannot reliably exclude abruption. This woman's characteristic pain, uterine hypertonicity and tenderness, bleeding, pre-eclampsia and abnormal fetal heart rate provide a compelling clinical picture despite negative imaging.

Option Validity

B) Failure to visualise a retroplacental clot does not exclude abruption.

C) A normally situated placenta does not convert this clinical picture into placenta praevia.

D) Acute haemoglobin may remain initially preserved and is not required to establish clinical suspicion.

E) Management cannot appropriately be deferred until postpartum placental examination.

F) Maternal haemodynamic stability does not exclude significant placental separation.

G) Fetal heart rate abnormalities are clinically important evidence of fetal compromise.

H) MRI is not required before acting on a strong clinical diagnosis of abruption.

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Updated

2026-10-06 01:57:35

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