A 31-year-old woman, G2P1, at 28 weeks gestation is involved in a road traffic accident. On examination, uterine tenderness and rigidity are present. Ultrasound shows a retroplacental clot. Fetal heart rate tracing shows late decelerations. Coagulation profile reveals prolonged PT/aPTT and fibrinogen of 120 mg/dL. The MOST likely complication accounting for the coagulation findings is:

• A Disseminated intravascular coagulation (DIC) ✓
• B Immune thrombocytopenic purpura
• C Von Willebrand disease
• D Thrombotic thrombocytopenic purpura

Explanation

Severe abruptio placentae is a well-recognised trigger of DIC in obstetrics because the retroplacental haematoma releases thromboplastin into the maternal circulation, activating the coagulation cascade. DIC is characterised by consumption of clotting factors and platelets, resulting in prolonged PT/aPTT, low fibrinogen (<150 mg/dL in pregnancy is abnormal), and elevated D-dimer. Prompt delivery and replacement of clotting factors are essential.

Reference: Williams Obstetrics, 26th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.