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Question 176
Delivery suite → Haemorrhage
Classification
Question
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A woman with severe placental abruption is undergoing resuscitation. Her first laboratory results show Hb 109 g/L, platelets 168 × 10⁹/L and normal coagulation studies. Forty-five minutes later, despite continuing haemorrhage, a clinician argues that significant consumptive coagulopathy is unlikely because the original results were normal. Which response is most appropriate?
Question Stem
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Options
A
The initial results exclude DIC unless haemorrhage exceeds 2000 mL
B
Normal platelets exclude subsequent coagulation-factor consumption
C
Coagulopathy develops only after fetal death in placental abruption
D
Continuing abruption can produce rapidly evolving coagulopathy, so serial clinical and laboratory reassessment is required
E
Repeat coagulation testing is useful only after delivery
Explanation
Severe abruption can produce rapid consumption of platelets, fibrinogen and other coagulation factors. Laboratory results therefore represent the haemostatic state at the time the sample was obtained, not a guarantee of subsequent stability. Continuing haemorrhage may produce significant deterioration within a short period. Serial laboratory testing must accompany repeated clinical assessment and should guide evolving blood-component replacement without delaying necessary resuscitation or delivery.
Option Validity
A) Coagulopathy is not dependent on reaching a fixed external blood-loss threshold.
B) An initially normal platelet count does not prevent later consumptive coagulopathy.
C) Abruption-associated coagulopathy can occur with a live fetus as well as following fetal death.
E) Serial coagulation assessment is important during active major haemorrhage, not merely after delivery.
Further Reading
RCOG Green-top Guideline No. 63. Antepartum Haemorrhage. Royal College of Obstetricians and Gynaecologists; 2011.