Intrauterine fetal death: coagulopathy: practice question

A OBG question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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OBG · Intrauterine fetal death: coagulopathy

Sample item

A woman presents at 34 weeks with absent fetal movements, and ultrasound confirms intrauterine death which was diagnosed 5 weeks ago elsewhere. Which test must be done before induction?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

B. Fibrinogen level and coagulation profile

Retained dead fetus for more than 3 to 4 weeks may release thromboplastin and cause hypofibrinogenaemia and DIC. Fibrinogen and platelet counts should be checked before induction, and blood products arranged if abnormal. Labour is then induced with mifepristone and misoprostol.

Option by option

  • A. Kleihauer-Betke test only

    A Kleihauer test is separate and is for fetomaternal haemorrhage assessment.

  • B. Fibrinogen level and coagulation profile (correct)

    Correct. Prolonged retention risks DIC, so fibrinogen and coagulation studies are needed first.

  • C. Serum alpha-fetoprotein

    AFP does not address coagulopathy.

  • D. Amniotic fluid lecithin to sphingomyelin ratio

    Lung maturity testing is irrelevant to a dead fetus.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this OBG question

What is the answer to this OBG question?

The best answer is B, Fibrinogen level and coagulation profile. Retained dead fetus for more than 3 to 4 weeks may release thromboplastin and cause hypofibrinogenaemia and DIC.

Why is "Kleihauer-Betke test only" not the answer?

A Kleihauer test is separate and is for fetomaternal haemorrhage assessment.

Why is "Serum alpha-fetoprotein" not the answer?

AFP does not address coagulopathy.

Why is "Amniotic fluid lecithin to sphingomyelin ratio" not the answer?

Lung maturity testing is irrelevant to a dead fetus.

What concept does this question test?

It tests Intrauterine fetal death: coagulopathy in OBG. Fibrinogen and platelet counts should be checked before induction, and blood products arranged if abnormal. Labour is then induced with mifepristone and misoprostol.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Intrauterine fetal death: coagulopathy?

Learn management algorithms as steps: PPH, eclampsia, ectopic pregnancy. Then use the flashcards and the other OBG questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.