Clinical Expert Series
Disseminated Intravascular Coagulation Syndromes in Obstetrics
F. Gary Cunningham, MD and David B. Nelson, MD
Obstet Gynecol 2015;126(5)
Continuing Medical Education credit is provided through joint sponsorship with
The American College of Obstetricians and Gynecologists.
ACCME Accreditation
The American College of Obstetricians and Gynecologists (the College) is accredited by the Accreditation Council for
Continuing Medical Education (ACCME) to provide continuing medical education for physicians.
AMA PRA Category 1 Credit(s)™
The American College of Obstetricians and Gynecologists designates this enduring material for a maximum of 2 AMA PRA
Category 1 Credits.™ Physicians should claim only the credit commensurate with the extent of their participation in the activity.
College Cognate Credit(s)
The American College of Obstetricians and Gynecologists designates this enduring material for a maximum of 2 Category 1
College Cognate Credits. The College has a reciprocity agreement with the AMA that allows AMA PRA Category 1 Credits™ to
be equivalent to College Cognate Credits.
Disclosure Statement
Current guidelines state that continuing medical education (CME) providers must ensure that CME activities are free from the
control of any commercial interest. All authors, reviewers, and contributors have disclosed to the College all relevant financial
relationships with any commercial interests. The authors, reviewers, and contributors declare that neither they nor any
business associate nor any member of their immediate families has financial interest or other relationships with any
manufacturer of products or any providers of services discussed in this program. Any conflicts have been resolved through
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Submission
Before submitting this form, please print a completed copy as confirmation of your program participation.
College Fellows: To obtain credits, complete and return this form by e-mail (obgyn@greenjournal.org) or fax (202-4790830). Your score, and a copy of the answer key, will be e-mailed to you after receipt of a completed quiz. Credit will be
recorded for those participants answering 80–100% of questions correctly. College Fellows may check their transcripts
online at http://www.acog.org, and any questions related to transcripts may be directed to educationcme@acog.org. For other
queries, please contact the Obstetrics & Gynecology Editorial Office, 202-314-2317 (phone) or obgyn@greenjournal.org (email).
Non–College Fellows: To obtain credits, submit the printout of the completed quiz to your accrediting institution. The printout
of the completed quiz is documentation for your continuing medical education credits.
Continuing medical education credit for “Disseminated Intravascular Coagulation Syndromes in Obstetrics” will be
available through November 2018.
1. Disseminated intravascular coagulation is currently thought to be initiated by:
Fibrinolysin
Prostacyclin
Prostaglandin F2a
Thrombin
Thromboplastin (tissue factor)
CME Quiz for the Clinical Expert Series
Obstet Gynecol 2015;126(5)
Credit available through November 2018
Page 1 of 3
2. The initiation of clotting is triggered by:
Activated factor X
Activated plasminogen
D-dimer
Plasmin
Prostaglandin I2 (prostacyclin)
3. Which of the following values is usually increased in pregnancy, but would be considered abnormal
in a nonpregnant adult?
Bleeding time
D-dimer
Factor V (%)
International Normalized Ratio (INR)
Partial thromboplastin time, activated (PTT)
4. The central feature in the management of disseminated intravascular coagulation is recognizing the
concomitant:
Increase in renal filtration rate
Reduction in hemoglobin
Risk of peripheral thrombosis
Risk to the fetus during pregnancy
Underlying disorder
5. The obstetric condition most commonly associated with an abnormally low fibrinogen level is:
Eclampsia
Hemolysis, elevated liver enzymes, and low platelet count (HELLP) syndrome
Preterm labor
Pyelonephritis
Total abruption
6. The obstetric condition most closely associated with an elevated fibrin-split products (eg, D-dimer)
level is:
Eclampsia
HELLP syndrome
Preterm labor
Pyelonephritis
Total abruption
CME Quiz for the Clinical Expert Series
Obstet Gynecol 2015;126(5)
Credit available through November 2018
Page 2 of 3
7. The intensity of clotting and consumption of coagulation factors which occur in patients with
placental abruption is most likely related to the:
Amount of placental tissue involved
Gender of the fetus
Level of maternal hemoglobin
Parity
Size of intrauterine clot formed
8. Appreciable hepatic dysfunction characterized by low cholesterol and high bilirubin levels, low levels
of fibrinogen and other procoagulants, and a prolonged prothrombin time are characteristic of:
Acute fatty liver of pregnancy
Amniotic fluid embolus
Disseminated intravascular coagulopathy
Eclampsia
HELLP syndrome
9. In preeclampsia, eclampsia, and HELLP syndrome, the coagulation factor or assessment that is most
likely to differ from that found in normal pregnancy is:
D-dimer
Factor V
Fibrinogen
Fibrin-split products
Platelet count
10. The most commonly encountered obstetric condition that results in consumptive coagulopathy is:
Acute fatty liver of pregnancy
Eclampsia
HELLP syndrome
Massive obstetric hemorrhage
Partial placental abruption
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CME Quiz for the Clinical Expert Series
Obstet Gynecol 2015;126(5)
Credit available through November 2018
Page 3 of 3