EMQ

EMQ — Extended Matching Question · Review

Question 291

Delivery suite → Haemorrhage

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Type EEMQ

UUID 2420382d-4628-403b-95fa-c624ef5cf017

Classification

Speciality

Obstetrics and Gynaecology

Group

Clinical

Title

Delivery suite

Topic

Haemorrhage

Subtopic 1

Antepartum haemorrhage

Subtopic 2

General

Subtopic 3

Tocolysis contraindication placental abruption

Question Type

EMQ

Question

EEMQ

Question Header

Question Stem

A 29-year-old G3P1 at 29+5 weeks presents with vaginal bleeding and regular painful contractions. She has received the first dose of antenatal corticosteroids. Initially her pulse is 98/min, blood pressure 118/70 mmHg and CTG is reassuring. Over the next 30 minutes she develops constant abdominal pain, increasing uterine tenderness and persistent hypertonicity. Bleeding increases and the CTG develops recurrent late decelerations. The neonatal team would prefer another 24 hours for corticosteroid benefit if pregnancy can be prolonged.

Answer Bank

A Start nifedipine because completing corticosteroids takes priority over the evolving APH

B Use atosiban because it cannot affect placental bleeding

C Do not use tocolysis to delay delivery when placental abruption with maternal or fetal compromise is suspected

D Continue pregnancy until ultrasound demonstrates a retroplacental clot

E Tocolysis is mandatory at this gestation if the cervix is less than 4 cm

F Give repeated tocolytic doses until fetal heart rate normalises

G Delay the management decision until haemoglobin falls

H Use tocolysis provided external blood loss remains below 500 mL

Correct Answer

C. Do not use tocolysis to delay delivery when placental abruption with maternal or fetal compromise is suspected

Explanation

Selective tocolysis can be considered in carefully chosen women with APH only when there is no maternal or fetal indication for delivery. This scenario has evolved into a strong clinical picture of placental abruption with worsening bleeding and fetal compromise. The potential benefit of completing corticosteroids cannot justify delaying indicated delivery. The management threshold is determined by the evolving maternal-fetal condition, not gestation or visible blood-loss volume alone.

Option Validity

A) Corticosteroid completion must not delay delivery when maternal or fetal compromise develops.

B) Choice of tocolytic agent does not remove the contraindication created by suspected abruption with compromise.

D) Ultrasound cannot reliably exclude abruption and should not delay indicated management.

E) Gestation and cervical dilatation do not make tocolysis mandatory in an unsafe clinical situation.

F) Pathological fetal heart rate abnormalities require assessment and definitive management rather than repeated tocolysis.

G) Acute haemoglobin may initially remain preserved and should not delay action.

H) Visible blood loss may underestimate haemorrhage and does not make tocolysis appropriate.

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Updated

2026-10-06 01:57:35

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