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Postpartum haemorrhage with low fibrinogen — FRCA Final MCQ

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HardObstetric AnaesthesiaPostpartum haemorrhage with low fibrinogenFRCA Final

A 31-year-old woman has major postpartum haemorrhage from uterine atony after caesarean section under spinal anaesthesia. Estimated blood loss is 1800 ml, heart rate 132/min, blood pressure 78/42 mmHg, fibrinogen is 1.4 g/L, and uterotonics are underway. What is the most appropriate management?

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Correct answer: C — Activate major haemorrhage protocol with early fibrinogen replacement

This is major obstetric haemorrhage with shock and hypofibrinogenaemia; major haemorrhage protocol activation with balanced blood products, tranexamic acid and early fibrinogen replacement is indicated. Crystalloid-heavy resuscitation worsens dilutional coagulopathy. Waiting for cross-matched blood delays resuscitation in shock. The low fibrinogen is particularly important in obstetric haemorrhage because it predicts severity.

Reference: OAA obstetric haemorrhage guidance; NICE NG235 caesarean birth; BSH major haemorrhage guidance