Postpartum haemorrhage: massive transfusion: 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 · Postpartum haemorrhage: massive transfusion

Sample item

A woman with major obstetric haemorrhage has received 4 units of red cells and remains in shock with ongoing bleeding. Which approach to blood product replacement is recommended?

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

The answer and the reasoning

C. A balanced ratio such as red cells to plasma to platelets near 1:1:1, with early fibrinogen replacement and tranexamic acid

Massive obstetric haemorrhage leads to dilutional and consumptive coagulopathy, and early balanced replacement with plasma, platelets and cryoprecipitate or fibrinogen concentrate prevents the lethal triad of acidosis, hypothermia and coagulopathy. Tranexamic acid 1 g IV is given early, and calcium is replaced. Massive transfusion protocols standardise this response.

Option by option

  • A. Crystalloid up to 5 litres before any blood

    Large crystalloid volumes cause dilution, acidosis and hypothermia.

  • B. Red cells alone until haemoglobin normalises

    Red cells alone worsen dilutional coagulopathy.

  • C. A balanced ratio such as red cells to plasma to platelets near 1:1:1, with early fibrinogen replacement and tranexamic acid (correct)

    Correct. Balanced products with fibrinogen and tranexamic acid treat shock and coagulopathy.

  • D. Albumin infusion alone

    Albumin does not replace clotting factors.

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 C, A balanced ratio such as red cells to plasma to platelets near 1:1:1, with early fibrinogen replacement and tranexamic acid. Massive obstetric haemorrhage leads to dilutional and consumptive coagulopathy, and early balanced replacement with plasma, platelets and cryoprecipitate or fibrinogen concentrate prevents the lethal triad of acidosis, hypothermia and coagulopathy.

Why is "Crystalloid up to 5 litres before any blood" not the answer?

Large crystalloid volumes cause dilution, acidosis and hypothermia.

Why is "Red cells alone until haemoglobin normalises" not the answer?

Red cells alone worsen dilutional coagulopathy.

Why is "Albumin infusion alone" not the answer?

Albumin does not replace clotting factors.

What concept does this question test?

It tests Postpartum haemorrhage: massive transfusion in OBG. Tranexamic acid 1 g IV is given early, and calcium is replaced. Massive transfusion protocols standardise this response.

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 Postpartum haemorrhage: massive transfusion?

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.