A 24-Year-Old Woman, Gravida 1 Para 0, at 28 Weeks

A 24-year-old woman, gravida 1 para 0, at 28 weeks gestation comes to the labor and delivery unit due to intense abdominal pain, vaginal bleeding, and absent fetal movement.  Temperature is 36.7 C (98.1 F) , blood pressure is 170/96 mm Hg, pulse is 108/min, and respirations are 22/min.  Pulse oximetry shows 98% on room air.  Physical examination shows a tense abdomen and a firm, tender uterus.  Ultrasound shows a hematoma between the placenta and the uterine wall and no fetal cardiac activity.  Laboratory results are as follows: The patient is hospitalized for further management.  Once hospitalized, she begins to experience bleeding from her gums and intravenous catheter sites.  Blood is also noted in the urinary catheter.  Vital signs are unchanged, and she reports no shortness of breath.  Which of the following is the most likely underlying cause of this patient's hospital symptoms?

A) Embolization of amniotic fluid into the maternal circulation
B) Ascending polymicrobial infection of the endometrial lining
C) Decidual tissue factor release into the maternal circulation
D) Hepatic fatty infiltration with decreased clotting factor production
E) Complete rupture of the endometrium, myometrium, and serosa

Correct Answer:

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