Normal pregnancy: fibrinogen in haemorrhage: practice question

A OBG question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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OBG · Normal pregnancy: fibrinogen in haemorrhage

Sample item

At a vaginal birth a multiparous woman has ongoing bleeding of 1200 mL despite uterotonics. Her fibrinogen is 180 mg/dL. Given that normal late-pregnancy fibrinogen is about 400 to 600 mg/dL, what is the most appropriate interpretation and action?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

B. Critically low and predictive of severe haemorrhage; give fibrinogen concentrate or cryoprecipitate

Fibrinogen is raised in pregnancy, so a level below 200 mg/dL during PPH strongly predicts progression to severe bleeding. Replacement with cryoprecipitate or fibrinogen concentrate is indicated along with treating the cause. Waiting for further results risks consumptive coagulopathy.

Option by option

  • A. Mildly low; give oral iron only

    Oral iron does nothing for acute coagulopathy.

  • B. Critically low and predictive of severe haemorrhage; give fibrinogen concentrate or cryoprecipitate (correct)

    Correct. A level under 200 mg/dL in PPH is ominous and needs fibrinogen replacement.

  • C. Normal for a postpartum woman; continue observation

    This is far below the expected pregnancy range, so it is not normal.

  • D. Irrelevant to bleeding; give platelets first

    Fibrinogen is the first factor to fall and is the most important to correct here.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this OBG question

What is the answer to this OBG question?

The best answer is B, Critically low and predictive of severe haemorrhage; give fibrinogen concentrate or cryoprecipitate. Fibrinogen is raised in pregnancy, so a level below 200 mg/dL during PPH strongly predicts progression to severe bleeding.

Why is "Mildly low; give oral iron only" not the answer?

Oral iron does nothing for acute coagulopathy.

Why is "Normal for a postpartum woman; continue observation" not the answer?

This is far below the expected pregnancy range, so it is not normal.

Why is "Irrelevant to bleeding; give platelets first" not the answer?

Fibrinogen is the first factor to fall and is the most important to correct here.

What concept does this question test?

It tests Normal pregnancy: fibrinogen in haemorrhage in OBG. Replacement with cryoprecipitate or fibrinogen concentrate is indicated along with treating the cause. Waiting for further results risks consumptive coagulopathy.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Normal pregnancy: fibrinogen in haemorrhage?

Learn management algorithms as steps: PPH, eclampsia, ectopic pregnancy. Then use the flashcards and the other OBG questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.