Massive antepartum haemorrhage at 30 weeks — emergency management station

Team-based emergency station: massive undifferentiated antepartum haemorrhage at 30 weeks with an unknown placental site. Tests parallel resuscitation, the vaginal-examination rule, massive haemorrhage activation, the decision to deliver, anti-D, and structured handover. Includes assessor timeline, marking domains, assessor key and fail criteria.

Prompt

A 27-year-old G1P0 at 30+2 weeks is brought to the birth suite by ambulance with heavy fresh vaginal bleeding that started 20 minutes ago at home. She has soaked her clothing and the ambulance sheet. She has had no antenatal scan since 12 weeks. She is RhD negative. On arrival: HR 134 bpm, BP 84/48 mmHg, RR 26, cold peripheries, GCS 15. You are the registrar; the consultant is 20 minutes away and has been called.

Station brief

Format. Emergency management station, approximately 12 minutes. You are the obstetric registrar in the birth suite. A senior midwife and an anaesthetic registrar are with you; the consultant obstetrician is 20 minutes away and has been called. The assessor runs the clock and feeds you new observations and results. ^[1]

Candidate instruction. Lead the management of a massive antepartum haemorrhage with an unknown placental site at 30+2 weeks. Verbalise your actions, your drug orders with doses, your escalation triggers, and your communication with the team, the woman and the consultant. ^[1]^[2]

References7Show

[1]Jauniaux E, Bhide A, Hussein AM, et al. Placenta Praevia and Placenta Accreta Spectrum: Diagnosis and Management: Green-Top Guideline No. 27a BJOG, 2026.PMID 42374711
[2]Oyelese Y, Ananth CV Placental abruption Obstet Gynecol, 2006.PMID 17012465
[3]Erez O, Mastrolia SA, Thachil J Disseminated intravascular coagulation in pregnancy: insights in pathophysiology, diagnosis and management Am J Obstet Gynecol, 2015.PMID 25840271
[4]Charbit B, Mandelbrot L, Samain E, et al. The decrease of fibrinogen is an early predictor of the severity of postpartum hemorrhage J Thromb Haemost, 2007.PMID 17087729
[5]Qureshi H, Massey E, Kirwan D, et al. BCSH guideline for the use of anti-D immunoglobulin for the prevention of haemolytic disease of the fetus and newborn Transfus Med, 2014.PMID 25121158
[6]McGoldrick E, Stewart F, Parker R, Dalziel SR Antenatal corticosteroids for accelerating fetal lung maturation for women at risk of preterm birth Cochrane Database Syst Rev, 2020.PMID 33368142
[7]Shepherd ES, Goldsmith S, Doyle LW, et al. Magnesium sulphate for women at risk of preterm birth for neuroprotection of the fetus Cochrane Database Syst Rev, 2024.PMID 38726883

Massive antepartum haemorrhage at 30 weeks — emergency management station

Station brief

References7Show

[1]Jauniaux E, Bhide A, Hussein AM, et al. Placenta Praevia and Placenta Accreta Spectrum: Diagnosis and Management: Green-Top Guideline No. 27a BJOG, 2026.PMID 42374711
[2]Oyelese Y, Ananth CV Placental abruption Obstet Gynecol, 2006.PMID 17012465
[3]Erez O, Mastrolia SA, Thachil J Disseminated intravascular coagulation in pregnancy: insights in pathophysiology, diagnosis and management Am J Obstet Gynecol, 2015.PMID 25840271
[4]Charbit B, Mandelbrot L, Samain E, et al. The decrease of fibrinogen is an early predictor of the severity of postpartum hemorrhage J Thromb Haemost, 2007.PMID 17087729
[5]Qureshi H, Massey E, Kirwan D, et al. BCSH guideline for the use of anti-D immunoglobulin for the prevention of haemolytic disease of the fetus and newborn Transfus Med, 2014.PMID 25121158
[6]McGoldrick E, Stewart F, Parker R, Dalziel SR Antenatal corticosteroids for accelerating fetal lung maturation for women at risk of preterm birth Cochrane Database Syst Rev, 2020.PMID 33368142
[7]Shepherd ES, Goldsmith S, Doyle LW, et al. Magnesium sulphate for women at risk of preterm birth for neuroprotection of the fetus Cochrane Database Syst Rev, 2024.PMID 38726883