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Question 78
Delivery suite → Haemorrhage
Classification
Question
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A woman at 36 weeks presents with major antepartum haemorrhage and haemodynamic instability. Which set of blood investigations is most appropriate during her initial assessment?
Question Stem
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Options
A
Full blood count and group-and-save only
B
Full blood count, coagulation screen and cross-match
C
Serum ferritin, vitamin B12 and folate
D
Kleihauer test as the only blood investigation
E
Liver function tests and bile acids only
Explanation
Major or massive APH requires urgent laboratory assessment alongside resuscitation. Full blood count is required to assess haematological status, although the initial haemoglobin concentration may not accurately reflect acute blood loss. Coagulation studies are important because major haemorrhage, particularly placental abruption, may be complicated by coagulopathy. Blood should also be cross-matched because transfusion may be required. In an RhD-negative woman, a Kleihauer test has an additional role in quantifying fetomaternal haemorrhage for anti-D requirements but does not replace the investigations required for major maternal haemorrhage.
Option Validity
A) group-and-save alone is insufficient in major haemorrhage when transfusion may be required.
C) haematinic investigations do not address the immediate risks of acute major APH.
D) Kleihauer testing does not assess maternal anaemia, coagulopathy or transfusion requirements.
E) these investigations do not constitute the core emergency blood assessment for major APH.
Further Reading
RCOG Green-top Guideline No. 63. Antepartum Haemorrhage. Royal College of Obstetricians and Gynaecologists; 2011.