SBA — Single Best Answer · Review
Question 153
Delivery suite → Haemorrhage
Classification
Question
SSBAQuestion Header
A woman at 37 weeks has a major placental abruption complicated by ongoing haemorrhage. Following red-cell and plasma replacement, bleeding continues from venepuncture sites. Her platelet count is 82 × 10⁹/L and fibrinogen is 0.8 g/L. Which abnormality should prompt particularly urgent targeted replacement because it indicates severe depletion of a coagulation substrate during obstetric haemorrhage?
Question Stem
—
Options
A
Platelet count of 82 × 10⁹/L
B
Fibrinogen of 0.8 g/L
C
Haemoglobin of 92 g/L
D
Mildly prolonged activated partial thromboplastin time
E
Leukocytosis
Explanation
Severe placental abruption may cause consumptive coagulopathy with marked depletion of fibrinogen. The massive-haemorrhage protocol included in the RCOG guideline sets therapeutic haemostatic goals and supports cryoprecipitate replacement when fibrinogen is severely reduced. A fibrinogen concentration of 0.8 g/L is therefore a critical abnormality in a woman with continuing obstetric haemorrhage and clinical coagulopathy. Management should remain integrated rather than treating a laboratory value in isolation: maternal resuscitation, control of the obstetric source, red-cell replacement and correction of coagulation abnormalities must proceed concurrently.
Option Validity
A) Thrombocytopenia is clinically relevant, but the profound fibrinogen depletion presented here is a particularly important target for replacement.
C) Haemoglobin concentration informs red-cell management but does not identify the specific coagulation substrate deficiency demonstrated here.
D) Prolonged clotting times may indicate coagulopathy but do not identify the profound fibrinogen depletion demonstrated in this case.
E) Leukocytosis does not explain the haemostatic failure associated with severe obstetric haemorrhage.
Further Reading
RCOG Green-top Guideline No. 63. Antepartum Haemorrhage. Royal College of Obstetricians and Gynaecologists; 2011.