SBA — Single Best Answer · Review
Question 118
Delivery suite → Haemorrhage
Classification
Question
SSBAQuestion Header
A woman at 36+5 weeks has a major placental abruption with continuing haemorrhage. Despite red-cell replacement, she remains actively bleeding. The uterus is tense and tender. Laboratory results are delayed, but consumptive coagulopathy is strongly suspected. Which is the most appropriate management while definitive coagulation results are awaited?
Question Stem
—
Options
A
A) Continue packed red cells alone until the coagulation results are available
B
B) Delay additional blood components because empiric replacement may obscure the diagnosis
C
C) Give platelets alone because thrombocytopenia is the principal coagulation defect in abruption
D
D) Give fresh frozen plasma and consider cryoprecipitate as part of active management of suspected coagulopathy
E
E) Give tranexamic acid as a substitute for blood-component replacement
Explanation
Severe placental abruption can produce rapid consumption of clotting factors and disseminated intravascular coagulation. In relentless major haemorrhage, treatment must be guided by the clinical situation and should not be delayed while awaiting laboratory confirmation. RCOG's major obstetric haemorrhage guidance within the APH guideline supports early blood-component replacement, including fresh frozen plasma and cryoprecipitate where coagulopathy is suspected. Red cells restore oxygen-carrying capacity but do not replace depleted coagulation factors.
Option Validity
A) Red cells do not correct depletion of coagulation factors in consumptive coagulopathy.
B) Life-threatening haemorrhage should not remain untreated while laboratory results are awaited.
C) Abruption-associated coagulopathy is not simply isolated thrombocytopenia.
E) Antifibrinolytic therapy cannot substitute for appropriate replacement of depleted blood components.
Further Reading
RCOG Green-top Guideline No. 63. Antepartum Haemorrhage. Royal College of Obstetricians and Gynaecologists; 2011.