During massive obstetric hemorrhage, serial coagulation testing is performed. A plasma fibrinogen level below which threshold is recognized as the single best laboratory predictor of progression to severe postpartum hemorrhage and mandates fibrinogen replacement?

• A Below 1.0 g/L
• B Below 1.5 g/L
• C Below 2.0 g/L ✓
• D Below 4.0 g/L

Explanation

Fibrinogen is the coagulation factor that falls earliest in obstetric hemorrhage, and pregnancy raises baseline levels to 4 to 6 g/L. A level below 2 g/L during PPH is the strongest predictor of severe ongoing bleeding and is the accepted trigger for fibrinogen concentrate or cryoprecipitate in major guidelines. Waiting for levels near 1 g/L means waiting until decompensation, and 4 g/L is simply the normal pregnant range, not a replacement threshold.

Reference: RCOG Green-top Guideline No. 52: Prevention and Management of Postpartum Haemorrhage, 2016 revision ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.