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Question 154
Delivery suite → Haemorrhage
Classification
Question
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A woman with a major placental abruption is receiving active resuscitation for continuing blood loss. Her initial coagulation screen was normal, but haemorrhage has continued substantially during the subsequent 40 minutes. Which approach to laboratory assessment is most appropriate?
Question Stem
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Options
A
The normal initial coagulation screen excludes clinically important coagulopathy for the remainder of the haemorrhage
B
Repeat testing is unnecessary unless the platelet count falls below 50 × 10⁹/L
C
Coagulation studies should next be repeated routinely after 24 hours
D
Serial reassessment of haemoglobin, platelets and coagulation is required because the haemostatic state can change rapidly during continuing major haemorrhage
E
Laboratory monitoring should stop once blood-component therapy begins because transfusion invalidates subsequent results
Explanation
Major obstetric haemorrhage is dynamic. Continuing blood loss, consumption of coagulation factors and subsequent fluid and blood-component replacement can rapidly change haemoglobin, platelet count and coagulation status. This is particularly important in placental abruption, where consumptive coagulopathy may evolve quickly. A reassuring initial coagulation screen therefore cannot be assumed to remain valid during continuing haemorrhage. Laboratory assessment must be repeated according to the clinical course while resuscitation and definitive obstetric management continue.
Option Validity
A) Coagulopathy may evolve rapidly after an initially normal result, particularly during continuing placental abruption and major blood loss.
B) Repeat assessment should be driven by the ongoing clinical haemorrhage rather than by a single platelet threshold.
C) Deferring repeat coagulation assessment for 24 hours is inappropriate during active major obstetric haemorrhage.
E) Blood-component therapy does not remove the need for subsequent laboratory monitoring; repeat results help guide further replacement.
Further Reading
RCOG Green-top Guideline No. 63. Antepartum Haemorrhage. Royal College of Obstetricians and Gynaecologists; 2011.