WBR0167
| Author | [[PageAuthor::Yazan Daaboul, M.D. (Reviewed by Serge Korjian and Alison Leibowitz [1])]] |
|---|---|
| Exam Type | ExamType::USMLE Step 1 |
| Main Category | MainCategory::Pathology |
| Sub Category | SubCategory::Reproductive |
| Prompt | [[Prompt::A 28-year-old pregnant woman, G2P1A0, at 25 weeks gestation, presents to the emergency department complaining of vaginal bleeding and painful continuous contractions. Following appropriate work-up, the physician explains to the patient that her condition is caused by a premature detachment of the placenta from the site of implantation. Which of the following is a significant risk factor for this patient's condition?]] |
| Answer A | AnswerA::Young maternal age |
| Answer A Explanation | [[AnswerAExp::Older maternal age is associated with placental abruption.]] |
| Answer B | AnswerB::Prior C-section |
| Answer B Explanation | [[AnswerBExp::Prior C-section is not a classical risk factor for placental abruption. It is a significant risk factor for placenta accreta and placenta previa.]] |
| Answer C | AnswerC::Use of ACE inhibitors |
| Answer C Explanation | [[AnswerCExp::Use of ACE inhibitors is not a risk factor for placental abruption. Use of ACE inhibitors in pregnancy is contraindicated due to the teratogenic effects of ACE-inhibitors.]] |
| Answer D | AnswerD::Hypertension |
| Answer D Explanation | [[AnswerDExp::Hypertension and preeclampsia are significant risk factors for placental abruption.]] |
| Answer E | AnswerE::Gestational diabetes |
| Answer E Explanation | [[AnswerEExp::Gestational diabetes is not a classical risk factor for placental abruption. However, gestational diabetes is associated with polyhydramnios, which may predispose to placental abruption.]] |
| Right Answer | RightAnswer::D |
| Explanation | [[Explanation::The patient presents with placental abruption during her second trimester. Abruption impacts about 1% of all pregnancies. It is characterized by the detachment of the placenta from the site of implantation. Placental abruption is thought to be a result of abnormal trophoblast invasion that results in rupture of the spiral arteries and early separation of the placenta. Placental abruption often manifests with painful vaginal bleeding that may be present in any trimester. The most significant risk factors for placental abruption are hypertension, preeclampsia, cocaine abuse, smoking, and trauma.
List of common risk factors for placental abruption is shown below:
Abruption that involves more than 50% of the placenta is frequently associated with fetal demise. Placental abruption should always be considered in the differential diagnosis of vaginal bleeding with abdominal pain and uterine contractions. Most importantly, placental abruption is associated with disseminated intravascular coagulopathy (DIC), which may lead to maternal shock and death. If fetal demise has occurred, vaginal delivery is the optimal management plan. If the fetus is alive near the end of gestation, conservative management may be attempted before vaginal or cesarean delivery, depending on the reassurance of the patient and the fetus's condition. |
| Approved | Approved::Yes |
| Keyword | WBRKeyword::Placental, WBRKeyword::Abruption, WBRKeyword::Placenta, WBRKeyword::Abruptio, WBRKeyword::Placentae, WBRKeyword::Cocaine, WBRKeyword::Smoking, WBRKeyword::Hypertension, WBRKeyword::Risk factor, WBRKeyword::Risk factors, WBRKeyword::Vaginal bleeding, WBRKeyword::Pregnant, WBRKeyword::Pregnancy |
| Linked Question | Linked:: |
| Order in Linked Questions | LinkedOrder:: |