EMQ

EMQ — Extended Matching Question · Review

Question 293

Delivery suite → Haemorrhage

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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

Anaesthesia haemodynamic and coagulation assessment

Question Type

EMQ

Question

EEMQ

Question Header

Question Stem

A 34-year-old G2P1 at 37+1 weeks requires urgent caesarean birth after APH. She initially lost approximately 700 mL but has responded to resuscitation. Pulse is now 92/min, blood pressure 118/74 mmHg and there is no continuing heavy bleeding. Platelets are 176 × 10⁹/L and coagulation studies are normal. In the adjacent theatre another woman with severe abruption is hypotensive with platelets 48 × 10⁹/L and markedly abnormal coagulation. The trainee asks whether the diagnosis of APH itself determines whether regional anaesthesia can be used.

Answer Bank

A Regional anaesthesia is contraindicated after every episode of APH

B Placental abruption itself is an absolute contraindication to neuraxial anaesthesia

C Caesarean birth after APH always requires general anaesthesia

D Anaesthetic choice should incorporate maternal haemodynamic stability and haemostatic status; regional anaesthesia may be appropriate when these are satisfactory

E Platelet count and coagulation status are irrelevant once delivery is urgent

F Regional anaesthesia is determined only by estimated external blood loss

G Fetal condition alone determines whether neuraxial anaesthesia is safe

H Regional anaesthesia becomes safe automatically once systolic blood pressure exceeds 100 mmHg

Correct Answer

D. Anaesthetic choice should incorporate maternal haemodynamic stability and haemostatic status; regional anaesthesia may be appropriate when these are satisfactory

Explanation

APH is not itself an absolute contraindication to regional anaesthesia. The relevant distinction is the woman's current haemodynamic and haemostatic condition. Regional anaesthesia may be considered when she is stable and coagulation is satisfactory, whereas major ongoing haemorrhage, haemodynamic instability or significant coagulopathy materially alters the safety of neuraxial techniques. Anaesthetic planning should therefore be individualised and integrated with the urgency of obstetric management.

Option Validity

A) APH alone does not universally prohibit regional anaesthesia.

B) Abruption as a diagnosis is not by itself an absolute neuraxial contraindication.

C) General anaesthesia is not mandatory for every caesarean birth following APH.

E) Haemostatic status is highly relevant to the safety of neuraxial techniques.

F) External blood-loss volume alone cannot determine anaesthetic suitability.

G) Fetal condition affects urgency but does not alone determine maternal neuraxial safety.

H) Blood pressure is only one component of maternal assessment and does not override significant coagulopathy.

Source & metrics

Authored Difficulty

5.00

Evaluation Score

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Destination

eBook

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Updated

2026-10-06 01:57:35

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