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Question 93
Delivery suite → Haemorrhage
Classification
Question
SSBAQuestion Header
A woman at 38 weeks presents with a major placental abruption. She is actively bleeding and requires resuscitation. Which complication should be specifically anticipated because of the underlying diagnosis?
Question Stem
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Options
A
Disseminated intravascular coagulation
B
Autoimmune haemolytic anaemia
C
Immune thrombocytopenia
D
Factor VIII inhibitor formation
E
Thrombotic thrombocytopenic purpura
Explanation
Major placental abruption is particularly associated with consumption coagulopathy and disseminated intravascular coagulation (DIC). Tissue factor released from the damaged placental bed can activate coagulation extensively, while ongoing haemorrhage further consumes and dilutes clotting factors. Coagulation studies and fibrinogen should therefore be monitored closely during significant abruption. Blood-component therapy should be guided by the clinical situation, haemorrhage protocol and laboratory results where these are available without delaying resuscitation.
Option Validity
B) autoimmune haemolytic anaemia is not the characteristic haemostatic complication of placental abruption.
C) immune thrombocytopenia is an immune-mediated disorder rather than the typical acute coagulopathy associated with abruption.
D) acquired factor VIII inhibitors are not the characteristic mechanism of coagulopathy in placental abruption.
E) TTP has a different pathophysiology and is not the typical haemostatic complication of major abruption.
Further Reading
RCOG Green-top Guideline No. 63. Antepartum Haemorrhage. Royal College of Obstetricians and Gynaecologists; 2011.