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Question 182
Delivery suite → Haemorrhage
Classification
Question
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A woman with major placental abruption has continuing haemorrhage during resuscitation. Serial results are: Hb: 121 → 94 g/L; Platelets: 176 → 68 × 10⁹/L; Fibrinogen: 3.6 → 1.0 g/L; PT and APTT: initially normal → prolonged. Which interpretation best integrates these changes?
Question Stem
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Options
A
The pattern is most consistent with iron-deficiency anaemia unmasked by intravenous fluids
B
The falling haemoglobin alone explains all abnormalities
C
The platelet fall is likely incidental because thrombocytopenia is unrelated to abruption
D
The evolving combination supports consumptive coagulopathy associated with continuing severe placental abruption
E
The normal initial coagulation results exclude DIC, so the later abnormalities should be attributed to laboratory error
Explanation
The serial trend is more informative than any isolated result. Falling platelets and fibrinogen with prolongation of clotting times during continuing severe abruption strongly support evolving consumptive coagulopathy. The initially normal coagulation profile does not exclude subsequent DIC because the haemostatic state can deteriorate rapidly as placental separation and haemorrhage continue. Management requires ongoing maternal resuscitation, repeated laboratory assessment, appropriate component replacement and definitive obstetric management rather than interpreting each abnormality independently.
Option Validity
A) Iron deficiency does not explain rapidly falling platelets, fibrinogen and prolongation of coagulation times.
B) Falling haemoglobin reflects blood loss but does not itself cause the entire consumptive coagulation pattern.
C) Thrombocytopenia may be an important component of consumptive coagulopathy in severe abruption.
E) An initially normal coagulation profile does not prevent subsequent rapid development of coagulopathy.
Further Reading
RCOG Green-top Guideline No. 63. Antepartum Haemorrhage. Royal College of Obstetricians and Gynaecologists; 2011.