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Question 158
Delivery suite → Haemorrhage
Classification
Question
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A woman at 39 weeks presents with catastrophic APH and profound cardiovascular collapse. Two large-bore intravenous cannulae are inserted and blood is sent urgently for cross-match. Despite crystalloid resuscitation, she remains severely hypotensive with continuing haemorrhage. Cross-matched blood is not yet available. Which is the most appropriate transfusion strategy?
Question Stem
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Options
A
Continue crystalloid until fully cross-matched blood becomes available
B
Delay red-cell transfusion until haemoglobin is known
C
Use emergency compatible blood without waiting for completion of full cross-matching
D
Give fresh frozen plasma alone until cross-matching is complete
E
Withhold blood until estimated loss exceeds 1500 mL
Explanation
Life-threatening obstetric haemorrhage requires immediate restoration of circulating volume and oxygen-carrying capacity. Cross-matched blood is preferable when available, but transfusion must not be dangerously delayed in a woman with continuing catastrophic haemorrhage and cardiovascular collapse. Emergency compatible blood should therefore be used according to the major haemorrhage protocol while definitive cross-matching proceeds. Neither an initial haemoglobin result nor an arbitrary measured blood-loss threshold should delay transfusion when the clinical evidence demonstrates severe haemorrhagic shock.
Option Validity
A) Crystalloid alone is inadequate in continuing catastrophic blood loss and should not be used to postpone necessary red-cell replacement.
B) Initial haemoglobin concentration may not reflect the severity of acute haemorrhage and should not delay emergency transfusion.
D) Fresh frozen plasma replaces coagulation factors but does not provide adequate red-cell oxygen-carrying capacity.
E) Clinical haemorrhagic shock warrants escalation irrespective of whether measured blood loss has reached an arbitrary volume threshold.
Further Reading
RCOG Green-top Guideline No. 63. Antepartum Haemorrhage. Royal College of Obstetricians and Gynaecologists; 2011.