A patient at 22 weeks gestation is diagnosed as having IUD which occurred at 17 weeks but did not have a miscarriage. The patient is at increased risk of :
**Core Concept**
Intrauterine death (IUD) refers to the demise of a fetus in utero, often without a miscarriage. This condition can lead to the activation of the coagulation cascade and the consumption of clotting factors, resulting in a consumptive coagulopathy.
**Why the Correct Answer is Right**
Consumptive coagulopathy with hypofibrinogenemia is a known complication of IUD. The death of the fetus triggers the release of tissue factor into the maternal circulation, initiating the extrinsic coagulation pathway. This leads to the activation of factor X, which in turn activates prothrombin to thrombin, resulting in the conversion of fibrinogen to fibrin. As the process continues, fibrinogen is consumed, leading to hypofibrinogenemia. The combination of activated coagulation factors and decreased fibrinogen levels can result in a consumptive coagulopathy.
**Why Each Wrong Option is Incorrect**
**Option A:** Septic abortion is a complication of an infected miscarriage, which is not the case in this scenario.
**Option B:** Future infertility is not a direct consequence of IUD.
**Option D:** Ectopic pregnancy is a separate condition where the embryo implants outside the uterus, and is not related to IUD.
**Clinical Pearl / High-Yield Fact**
The risk of consumptive coagulopathy with hypofibrinogenemia can be minimized by delivering the fetus as soon as possible after the diagnosis of IUD.
**✓ Correct Answer: C. Consumptive coagulopathy with hypofibrinogenemia**