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Question 69
Delivery suite → Haemorrhage
Classification
Question
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A woman at 35 weeks presents with severe constant abdominal pain and only 50 mL of visible vaginal bleeding. She is pale, tachycardic and hypotensive, and her uterus is tense and tender. Which interpretation best explains the discrepancy between her clinical condition and measured vaginal blood loss?
Question Stem
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Options
A
Maternal hypotension makes visual estimation of blood loss unreliable
B
Significant haemorrhage may be concealed behind the placenta
C
The cardiovascular findings are unlikely to be related to the bleeding
D
Placental abruption generally causes only minor maternal blood loss
E
The vaginal blood loss should be used to classify the severity of haemorrhage
Explanation
In antepartum haemorrhage, particularly placental abruption, visible vaginal blood loss may substantially underestimate total blood loss because haemorrhage can remain concealed behind the placenta. Clinical assessment must therefore consider maternal cardiovascular status, abdominal findings and fetal condition rather than relying on measured external loss alone. A woman with tachycardia, hypotension and a tense tender uterus should be managed as having significant haemorrhage despite apparently modest vaginal bleeding.
Option Validity
A) . although visual estimation is imperfect, the key mechanism is concealed haemorrhage.
C) . maternal cardiovascular compromise may indicate substantial blood loss despite limited external bleeding.
D) . placental abruption can cause severe and life-threatening haemorrhage.
E) . severity must be assessed clinically and cannot be determined from visible vaginal loss alone.
Further Reading
RCOG Green-top Guideline No. 63. Antepartum Haemorrhage. 2011.