FCPS Part 2 Obs & Gynae QBank 2026

Why B is correct

Pregnancy is hypercoagulable, and fibrinogen rises to about 4 to 6 g/L at term. A fibrinogen of 1.8 g/L, inside the non-pregnant range, is therefore a large fall from her pregnant baseline. Fibrinogen is the first clotting factor to reach critical levels in obstetric haemorrhage, and a level below 2 g/L during PPH strongly predicts progression to severe bleeding. Guidelines advise keeping fibrinogen above 2 g/L during ongoing PPH, using cryoprecipitate or fibrinogen concentrate. Pakistan practice: In most Pakistani hospitals cryoprecipitate is the usual source of fibrinogen; fibrinogen concentrate is costly and stocked only in some tertiary centres.

Why the other options are wrong

AFresh frozen plasma 15 mL/kg

PT and APTT are normal, and FFP contains too little fibrinogen to raise it quickly.

CPlatelet transfusion

Usually given when platelets fall below 75 x10⁹/L with ongoing bleeding; 110 is adequate.

DIntravenous vitamin K

Corrects a deficiency of vitamin K-dependent factors with a raised PT, which is not the problem here.

EProthrombin complex concentrate

Replaces factors II, VII, IX and X for warfarin reversal; her PT is normal and the deficit is fibrinogen.

Exam pearl

In ongoing PPH, a fibrinogen under 2 g/L needs replacement, even if the lab flags it as normal.

Quick comparison

Shaded column: the answer in this question.

Key concepts

Term fibrinogen

About 4 to 6 g/L, so 2 g/L is already low.

Tranexamic acid

1 g IV within 3 hours of birth, repeat if bleeding continues.

Cryoprecipitate

Two pools raise fibrinogen by about 1 g/L.

Point of care

ROTEM or TEG guides replacement where available.