A 34-year-old woman has just given birth to a healthy baby boy. After the delivery of the baby, the physician proceeds to deliver the placenta. After it has been extracted from the mother's uterus, the resident examines it and notes that it appears incomplete. They try to deliver the remainder but are unsuccessful. A few moments later, the mother loses consciousness, and is bleeding profusely from her uterus. Blood is collected, and the results follow. PT: 17 sec (RR: 11.3-12.8 sec)
INR: 3.02
APTT: 67 sec (RR: 23-32 sec)
D-dimer: 540 ng/mL (RR:

Question

A 34-year-old woman has just given birth to a healthy baby boy. After the delivery of the baby, the physician proceeds to deliver the placenta. After it has been extracted from the mother's uterus, the resident examines it and notes that it appears incomplete. They try to deliver the remainder but are unsuccessful. A few moments later, the mother loses consciousness, and is bleeding profusely from her uterus. Blood is collected, and the results follow. PT: 17 sec (RR: 11.3-12.8 sec)
INR: 3.02
APTT: 67 sec (RR: 23-32 sec)
D-dimer: 540 ng/mL (RR: <400 ng/mL)
Fibrinogen: 82 mg/dL (RR: 200-400 mg/dL)
Factor V assay: 12%
Based on this information, from what is the most probable diagnosis?

Quizplus · Accepted Answer

The abnormal coagulation studies, including prolonged PT, APTT, elevated INR, decreased fibrinogen and factor V assay, and elevated D-dimer all suggest disseminated intravascular coagulation (DIC). The incomplete placental delivery and subsequent postpartum hemorrhage are also consistent with DIC, as DIC can occur as a result of severe obstetric complications such as placenta previa, abruption, and retained products of conception. Hemophilia A and von Willebrand's disease would lead to prolonged APTT but would not cause the abnormalities seen in other coagulation studies, including PT, INR, and factor assays.

A 34-Year-Old Woman Has Just Given Birth to a Healthy