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Question 95
Delivery suite → Haemorrhage
Classification
Question
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A woman at 36 weeks presents immediately after a major antepartum haemorrhage. She is tachycardic and hypotensive. Her initial haemoglobin concentration is 118 g/L. Which interpretation is most appropriate?
Question Stem
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Options
A
Major haemorrhage is excluded because haemoglobin is normal
B
Blood transfusion cannot be required unless haemoglobin falls below 70 g/L
C
Initial haemoglobin may underestimate the magnitude of acute blood loss
D
The cardiovascular abnormalities are therefore unlikely to represent hypovolaemia
E
Resuscitation should be delayed until haemoglobin is repeated
Explanation
The initial haemoglobin concentration may remain relatively normal during acute haemorrhage because whole blood is lost and haemodilution has not yet occurred. A normal initial haemoglobin therefore does not exclude severe blood loss and should never override clinical evidence of shock. Resuscitation and transfusion decisions in major APH must be based on the maternal clinical condition, ongoing blood loss and laboratory findings collectively rather than an isolated early haemoglobin measurement.
Option Validity
A) normal initial haemoglobin does not exclude major acute blood loss.
B) transfusion in active major haemorrhage is guided by clinical condition and ongoing loss, not a fixed haemoglobin threshold alone.
D) tachycardia and hypotension may represent haemorrhagic shock despite an initially normal haemoglobin.
E) urgent resuscitation must not wait for haemodilution or a repeat haemoglobin measurement.
Further Reading
RCOG Green-top Guideline No. 63. Antepartum Haemorrhage. Royal College of Obstetricians and Gynaecologists; 2011.