A patient with severe abruptio placentae develops generalized oozing from venepuncture sites and gums. Laboratory studies show prolonged PT and aPTT with fibrinogen of 90 mg/dL. What is the mechanism responsible for this coagulopathy?
- A Entry of thromboplastin from the retromaternal clot into the maternal circulation causing consumptive coagulopathy ✓
- B Immune-mediated destruction of platelets by maternal antibodies
- C Suppression of hepatic synthesis of clotting factors by placental hormones
- D Hemodilution from crystalloid resuscitation alone
Correct answer: A. Entry of thromboplastin from the retromaternal clot into the maternal circulation causing consumptive coagulopathy
Explanation
Abruptio placentae exposes the maternal circulation to decidual and placental tissue factor (thromboplastin), triggering widespread intravascular coagulation with consumption of fibrinogen, platelets, and factors V and VIII. This is why abruption is the commonest obstetric cause of DIC. Hemodilution alone cannot explain a fibrinogen of 90 mg/dL, and immune platelet destruction describes ITP, not this picture. Treatment requires fresh frozen plasma, cryoprecipitate, and platelets alongside delivery.
Reference: Williams Obstetrics, 25th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
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