Disseminated intravascular coagulation (DIC) in obstetric complications involves tissue factor (TF) release. Which obstetric condition is most commonly associated with acute fulminant DIC through massive TF release?

• A Preeclampsia with endothelial dysfunction causing chronic low-grade DIC
• B HELLP syndrome with microangiopathic hemolytic anemia and platelet consumption
• C Abruptio placentae with exposure of placental TF (trophoblast TF) into maternal circulation ✓
• D Retained dead fetus syndrome causing slow TF release over weeks

Explanation

Abruptio placentae (premature placental separation) is the obstetric condition most commonly causing acute, fulminant DIC through sudden release of massive amounts of tissue factor (TF) from the placenta into the maternal circulation. Placental trophoblasts express extremely high concentrations of TF on their membranes; abruption exposes this TF to maternal blood, triggering overwhelming thrombin generation, fibrin deposition, factor consumption, and secondary fibrinolysis (elevated D-dimers, low fibrinogen). Amniotic fluid embolism also causes acute DIC. Retained dead fetus syndrome (Couvelaire uterus) causes a subacute DIC over days-weeks via slow TF release; HELLP syndrome involves thrombocytopenia and hemolysis but DIC is not universal; preeclampsia is chronic endotheliopathy.

Reference: Robbins & Cotran Pathologic Basis of Disease, 10th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.