During an evolving major postpartum hemorrhage, serial point-of-care testing is performed. Which single laboratory value is the best early predictor that bleeding will become severe and that massive transfusion will be required?

• A Platelet count below 100 x 10^9/L
• B Hemoglobin below 7 g/dL
• C Fibrinogen below 200 mg/dL ✓
• D Prothrombin time prolongation beyond 3 seconds

Explanation

Fibrinogen falls earlier than other coagulation parameters in obstetric hemorrhage because pregnancy raises baseline levels to 400 to 600 mg/dL, so a value dropping toward 200 mg/dL signals substantial consumption. Studies show fibrinogen below 200 mg/dL is the strongest predictor of progression to severe PPH. Platelets and PT fall later, and hemoglobin lags behind actual red cell loss because dilution takes time.

Reference: Williams Obstetrics, 26th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.