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Question 82
Delivery suite → Haemorrhage
Classification
Question
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A woman at 37 weeks presents with massive antepartum haemorrhage. She is pale and confused, with a pulse of 145 beats/min and blood pressure of 65/35 mmHg. What is the most appropriate immediate vascular-access strategy?
Question Stem
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Options
A
One 22-gauge peripheral cannula
B
Wait for central venous access before starting resuscitation
C
Two large-bore peripheral intravenous cannulae
D
One standard cannula after ultrasound assessment
E
Intramuscular fluid administration while awaiting anaesthetic review
Explanation
Major or massive obstetric haemorrhage requires immediate resuscitation using rapid, reliable vascular access. Two large-bore peripheral intravenous cannulae should be established promptly to permit rapid administration of warmed fluids and blood components and simultaneous blood sampling. Resuscitation should not be delayed while waiting for central venous access or diagnostic investigations. Early multidisciplinary involvement, including senior obstetric, anaesthetic, haematology and laboratory support, is essential in major haemorrhage.
Option Validity
A) a single small-bore cannula is inadequate for rapid resuscitation in massive haemorrhage.
B) resuscitation should begin immediately through large peripheral access rather than waiting for a central line.
D) neither a single routine cannula nor delay for ultrasound provides adequate emergency access.
E) intramuscular administration cannot provide the rapid volume and blood-product replacement required.
Further Reading
RCOG Green-top Guideline No. 63. Antepartum Haemorrhage. Royal College of Obstetricians and Gynaecologists; 2011.