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Question 71
Delivery suite → Haemorrhage
Classification
Question
SSBAQuestion Header
A woman at 36 weeks arrives with heavy vaginal bleeding, pulse 130 beats/min and blood pressure 75/45 mmHg. The fetal heart is present. Which approach to fetal assessment is most appropriate during initial management?
Question Stem
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Options
A
Delay maternal resuscitation until a complete CTG has been interpreted
B
Perform fetal blood sampling before establishing intravenous access
C
Commence maternal resuscitation while assessing fetal wellbeing
D
Perform ultrasound biophysical profiling before giving intravenous fluids
E
Assess the fetus only after maternal haemodynamic parameters have completely normalised
Explanation
Severe APH requires immediate maternal resuscitation. Maternal and fetal assessment should proceed in parallel where possible, but maternal stabilisation takes priority because fetal wellbeing depends upon adequate maternal circulation. Fetal heart assessment and CTG can provide important information regarding fetal compromise, but investigations must not delay resuscitation of a haemodynamically unstable woman.
Option Validity
A) . CTG assessment must not delay maternal resuscitation.
B) . invasive fetal assessment must not precede emergency maternal stabilisation.
D) . biophysical profiling would delay essential resuscitation.
E) . fetal assessment can occur concurrently; complete maternal normalisation is not required before assessing fetal wellbeing.
Further Reading
RCOG Green-top Guideline No. 63. Antepartum Haemorrhage. 2011.