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Question 65
Delivery suite → Haemorrhage
Classification
Question
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An RhD-negative woman at 31 weeks presents with a significant antepartum haemorrhage. She has no anti-D antibodies. Which investigation is specifically required to determine whether additional anti-D immunoglobulin is necessary?
Question Stem
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Options
A
Direct antiglobulin test
B
Kleihauer test
C
Coagulation screen
D
Serum fibrinogen
E
Placental ultrasound
Explanation
In a non-sensitised RhD-negative woman with APH, the Kleihauer test is used to quantify fetomaternal haemorrhage and thereby determine whether additional anti-D immunoglobulin is required beyond the standard dose. Importantly, the test is not useful for diagnosing placental abruption. Other blood investigations may be necessary according to the severity of haemorrhage but do not quantify fetomaternal haemorrhage for anti-D dosing.
Option Validity
A) . this does not quantify fetomaternal haemorrhage for anti-D dosing.
C) . coagulation testing assesses haemostatic disturbance.
D) . fibrinogen helps assess coagulopathy rather than fetomaternal haemorrhage.
E) . ultrasound assesses placental location and fetal factors but cannot determine anti-D dose.
Further Reading
RCOG Green-top Guideline No. 63. Antepartum Haemorrhage. 2011.