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 are shown below. 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 are shown below. 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 patient most likely suffering?

Quizplus · Accepted Answer

The patient is most likely suffering from disseminated intravascular coagulation (DIC), which is a serious condition that can occur in the post-partum period. The incomplete delivery of the placenta can trigger a cascade of events that leads to widespread clotting and bleeding. The PT and APTT are prolonged, and the INR and D-dimer are elevated, which are all consistent with DIC. The low fibrinogen level and low factor V assay also suggest that the patient's clotting system is depleted. Hemophilia A and von Willebrand's disease are both bleeding disorders, but they are not associated with DIC. Placenta previa is a condition in which the placenta partially or completely covers the cervix, but it is not related to the patient's current symptoms.

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