A 22-year-old primigravida at 36 weeks presents with sudden severe abdominal pain, a woody-hard uterus, and dark vaginal bleeding. The fetal heart rate is absent. Her blood pressure is 90/60 mmHg and pulse is 120 bpm. Laboratory tests show fibrinogen 120 mg/dL, platelet count 80,000 per microliter, and prolonged PT/APTT. What is the MOST likely underlying pathophysiology of her coagulopathy?

• A Immune thrombocytopenic purpura
• B Von Willebrand disease
• C Hemolysis, elevated liver enzymes, low platelets syndrome
• D Disseminated intravascular coagulation ✓

Explanation

Abruptio placentae releases thromboplastin-like substances from the damaged decidua and placenta into the maternal circulation, triggering disseminated intravascular coagulation. The triad of hypofibrinogenemia, thrombocytopenia, and prolonged clotting times is classic for DIC. HELLP syndrome would present with hemolysis and elevated liver enzymes, not primarily a coagulopathy with low fibrinogen. ITP and von Willebrand disease do not cause this acute consumptive picture.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.