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Question 172
Delivery suite → Haemorrhage
Classification
Question
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A woman at 37+6 weeks has a severe placental abruption with continuing haemorrhage. After initial resuscitation she remains tachycardic but her blood pressure has improved. Results show Hb 96 g/L, platelets 58 × 10⁹/L, fibrinogen 0.9 g/L and prolonged PT and APTT. Which management concept is most appropriate?
Question Stem
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Options
A
Correct each abnormal laboratory result sequentially before proceeding to delivery
B
Prioritise red cells because haemoglobin is the single best marker of haemorrhage severity
C
Continue maternal resuscitation, correct the evolving coagulopathy with appropriate blood components and expedite definitive obstetric management concurrently
D
Defer blood-component therapy until repeat results confirm deterioration
E
Proceed to delivery without further haemostatic support because removal of the placenta will immediately normalise coagulation
Explanation
Severe abruption with ongoing haemorrhage and evolving consumptive coagulopathy requires integrated, simultaneous management. There is no safe sequential strategy in which resuscitation is completed, laboratory abnormalities are individually normalised and only then is the obstetric cause addressed. Maternal resuscitation, appropriate red-cell and haemostatic blood-component replacement, repeated laboratory assessment and expedited definitive obstetric management must proceed concurrently. The haemoglobin alone does not represent haemorrhage severity, and delivery does not instantly reverse established coagulopathy.
Option Validity
A) Sequential correction risks dangerous delay while haemorrhage and consumption continue.
B) Haemoglobin alone neither measures acute blood-loss severity reliably nor captures the major coagulation abnormalities present.
D) Clinically significant active coagulopathy should not remain untreated while repeat laboratory confirmation is awaited.
E) Delivery addresses the obstetric source but established coagulopathy still requires active correction and surveillance.
Further Reading
RCOG Green-top Guideline No. 63. Antepartum Haemorrhage. Royal College of Obstetricians and Gynaecologists; 2011.