A woman with postpartum haemorrhage from uterine atony has ongoing bleeding despite oxytocin, carboprost and tranexamic acid. Fibrinogen level is 1.1 g/L. The most appropriate next step in coagulation management is:

• A Continue fresh frozen plasma until fibrinogen exceeds 0.8 g/L
• B Give recombinant activated factor VII
• C Administer vitamin K 10 mg intravenously
• D Administer cryoprecipitate to maintain fibrinogen above 1.5 g/L ✓

Explanation

Fibrinogen falls early in obstetric haemorrhage and a level below 1.5 g/L predicts progression to severe PPH. Guidelines recommend maintaining fibrinogen above 1.5 g/L using cryoprecipitate or fibrinogen concentrate. Fresh frozen plasma cannot raise fibrinogen adequately without volume overload because its fibrinogen concentration is only about 2 to 4 g/L per unit distributed across a large volume. Vitamin K is irrelevant here and rFVIIa is a rescue agent after correction of fibrinogen, pH and calcium.

Reference: Miller's Anesthesia, 9th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.