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Question 94
Delivery suite → Haemorrhage
Classification
Question
SSBAQuestion Header
A woman at 27+4 weeks presents with massive antepartum haemorrhage. She is hypotensive and becoming confused. Fetal cardiac activity is present. Her partner asks the team to delay treatment until the neonatal team has assessed the likelihood of intact fetal survival. What is the most appropriate immediate principle of management?
Question Stem
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Options
A
Delay maternal intervention until fetal prognosis has been established
B
Prioritise maternal resuscitation immediately
C
Perform emergency ultrasound before vascular access
D
Administer corticosteroids before commencing blood transfusion
E
Prioritise continuous CTG interpretation over correction of maternal shock
Explanation
In major or massive APH, maternal resuscitation takes immediate priority irrespective of gestational age. Fetal wellbeing depends on adequate maternal circulation, and delaying correction of maternal shock worsens outcomes for both mother and fetus. Fetal assessment, neonatal involvement and decisions regarding delivery should occur concurrently where feasible, but they must not delay airway, breathing and circulation measures, large-bore intravenous access and appropriate blood-component replacement.
Option Validity
A) assessment of fetal prognosis must not delay treatment of life-threatening maternal haemorrhage.
C) diagnostic ultrasound must not precede immediate maternal resuscitation in haemodynamic instability.
D) corticosteroid administration must not delay treatment of maternal shock.
E) fetal monitoring is important but does not take priority over maternal resuscitation.
Further Reading
RCOG Green-top Guideline No. 63. Antepartum Haemorrhage. Royal College of Obstetricians and Gynaecologists; 2011.