Obstetrics & Gynecology>>>>>The Puerperium, Lactation, and Immediate Care of the Newborn
Question 3#

A 27-year-old G4P3 at 37 weeks presents to labor and delivery with heavy vaginal bleeding and painful uterine contractions. A bedside ultrasound demonstrates a fundal placenta. The patient’s vital signs are: blood pressure 140/92 mm Hg, pulse 118 beats per minute, respiratory rate 20 breaths per minute, and temperature 37°C (98.6°F). The fetal heart rate tracing reveals tachycardia with decreased variability and intermittent late decelerations. She is taken to the OR for an emergency cesarean, and delivers a male infant with Apgar scores of 4 and 9. When the placenta is delivered, a large retroplacental clot is noted. The patient becomes hypotensive, and bleeding is noted from the wound edges and her IV catheter sites.

Which of the following blood products will most quickly resolve her cause of hemorrhage?

A) Cryoprecipitate
B) Fresh frozen plasma (FFP)
C) Packed red blood cells
D) Platelets
E) Recombinant factor VII

Correct Answer is B

Comment:

This patient has a large placental abruption, which is the most common cause of consumptive coagulopathy in pregnancy. The bleeding described signifies that the patient has a significant coagulopathy with hypofibrinogenemia. Prompt and vigorous transfusion is needed. Packed red blood cells will restore blood volume and increase oxygen carrying capacity. FFP contains about 600 mg to 700 mg of fibrinogen and will promote clotting, and is the best choice to quickly resolve her cause of hemorrhage. Cryoprecipitate contains clotting factors and fibrinogen, but in a much lower amount (200 mg) than FFP, and has no advantage over the use of FFP in this bleeding patient. Recombinant factor VII can be used for the treatment of severe obstetrical hemorrhage but will not be effective if fibrinogen is low. Platelet transfusion is considered in bleeding patients with platelets less than 50,000.