MSFinals-4184
A 23-year-old woman with a history of bipolar disorder gives birth to a baby girl at home. She received no prenatal care, but when she found out she was pregnant, she started taking prenatal vitamins that she got from the pharmacist. Her only medication is valproic acid. It is 2 days since the birth, and the mother has brought her baby to the Emergency Department because she has become impossible to arouse. On examination, the baby is estimated to have been born at 35 weeks’ gestation. The baby is afebrile, with stable vital signs. A head ultrasound through the fontanelle shows an intracerebral haemorrhage in the germinal matrix. There are no calcifications. Retinal examination does not show petechial haemorrhages. A full skeletal survey is negative.
What is the most likely pathophysiologic mechanism underlying this baby’s haemorrhage?