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Combative head injury sedation — DipIMC MCQ

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HardTraumaCombative head injury sedationDipIMC

A 32-year-old at 36 weeks has painless heavy vaginal bleeding at home. She is haemodynamically stable, fetal movements are present and placenta praevia is known. What is the most appropriate pre-hospital management?

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Correct answer: B — Provide ABC care, omit digital examination and transfer urgently

The best answer is “Provide ABC care, omit digital examination and transfer urgently”. Known placenta praevia with heavy antepartum bleeding requires urgent obstetric assessment and transfer with maternal resuscitation and fetal-aware pre-alert. Digital vaginal examination can precipitate catastrophic haemorrhage and must be avoided outside the appropriate obstetric setting. Ultrasound, tocolysis and definitive management must not delay emergency transfer when active bleeding is reported.

Reference: RCOG Green-top Guideline 63, Antepartum haemorrhage: https://www.rcog.org.uk/media/pwdi1tef/gtg_63.pdf