EMQ

EMQ — Extended Matching Question · Review

Question 292

Delivery suite → Haemorrhage

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Type EEMQ

UUID 19748171-06d1-4168-920b-a1e3d812af59

Classification

Speciality

Obstetrics and Gynaecology

Group

Clinical

Title

Delivery suite

Topic

Haemorrhage

Subtopic 1

Antepartum haemorrhage

Subtopic 2

Placental abruption

Subtopic 3

Fetal death route of birth

Question Type

EMQ

Question

EEMQ

Question Header

Question Stem

A 37-year-old G4P2 at 36+4 weeks presents with placental abruption. Ultrasound confirms intrauterine fetal death. Following initial resuscitation she is haemodynamically stable, bleeding is controlled and coagulation studies are satisfactory. The fetus is cephalic, the cervix is 3 cm dilated and there is no previous uterine surgery or other obstetric indication for caesarean birth. A colleague proposes immediate caesarean section because abruption caused the fetal death.

Answer Bank

A Emergency caesarean section because fetal death following abruption is itself an operative indication

B Classical caesarean section to shorten the third stage

C Caesarean section because vaginal birth increases the risk of coagulopathy

D Expectant management for several days regardless of maternal condition

E Caesarean section once maternal haemoglobin has been corrected

F Caesarean section because the cervix is only 3 cm dilated

G Operative delivery solely to permit direct inspection of the placenta

H Aim for vaginal birth when the mother is stable and there is no separate obstetric indication for caesarean section

Correct Answer

H. Aim for vaginal birth when the mother is stable and there is no separate obstetric indication for caesarean section

Explanation

Following placental abruption with fetal death, caesarean birth provides no fetal benefit and may expose the mother to additional operative, anaesthetic and haemorrhagic risk. When maternal condition is stable and there is no independent obstetric indication for caesarean section, vaginal birth is generally preferred. The plan must remain dynamic because renewed haemorrhage or maternal deterioration may alter management.

Option Validity

A) Fetal death caused by abruption does not itself mandate caesarean birth.

B) Classical caesarean section has no routine role in this situation.

C) Caesarean birth may increase maternal operative haemorrhagic risk and is not used simply to prevent coagulopathy.

D) Prolonged delay may expose the mother to renewed bleeding and evolving coagulation abnormalities.

E) ion of haemoglobin does not create an operative indication.

F) Cervical dilatation of 3 cm alone does not mandate caesarean birth after fetal death.

G) Placental inspection does not justify exposing the mother to unnecessary operative delivery.

Source & metrics

Authored Difficulty

5.00

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Updated

2026-10-06 01:57:35

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