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Question 108
Delivery suite → Haemorrhage
Classification
Question
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A woman at 32 weeks presents with a small episode of vaginal bleeding that has stopped. She is haemodynamically stable, fetal assessment is reassuring and there is no clinical suspicion of placental abruption. Which statement regarding coagulation testing is most appropriate?
Question Stem
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Options
A
A coagulation screen is mandatory in every episode of spotting
B
Fibrinogen must be measured before speculum examination
C
Coagulation studies are required only after delivery
D
A normal haemoglobin eliminates the need for clinical assessment
E
Routine coagulation testing is generally unnecessary in minor bleeding without thrombocytopenia
Explanation
The extent of laboratory investigation in APH should reflect the severity of bleeding and the clinical picture. In minor haemorrhage, a full blood count is appropriate, but coagulation studies are not routinely required when the platelet count is normal and there is no clinical concern regarding coagulopathy. Major or massive haemorrhage requires more extensive investigation, including coagulation studies, because significant blood loss and placental abruption may be complicated by consumptive coagulopathy.
Option Validity
A) Coagulation testing is not mandatory for every minor episode of APH.
B) Fibrinogen measurement is not a prerequisite for speculum examination in a stable woman with minor bleeding.
C) Coagulation testing should be performed during significant APH when clinically indicated rather than being deferred until after delivery.
D) Haemoglobin concentration does not replace maternal and fetal clinical assessment.
Further Reading
RCOG Green-top Guideline No. 63. Antepartum Haemorrhage. Royal College of Obstetricians and Gynaecologists; 2011.