Study of pregnancy with disseminated intravascular coagulation

Authors

  • Satishchandra K. Kadikar Department of Obstetrics and Gynecology, Smt. SCL Hospital, Ahmedabad, Gujarat, India
  • Farheenbanu J. Diwan Department of Obstetrics and Gynecology, Smt. SCL Hospital, Ahmedabad, Gujarat, India
  • Usmaan Topiwala MBBS Student, Smt. SCL Hospital, Ahmedabad, Gujarat, India
  • Saliha Agasiwala Department of Obstetrics and Gynecology, Smt. SCL Hospital, Ahmedabad, Gujarat, India

DOI:

https://doi.org/10.18203/2320-1770.ijrcog20214335

Keywords:

Disseminated intravascular coagulation in pregnancy, Maternal morbidity and mortality

Abstract

Background: At present time, obstetric bleeding remains to be the world’s main cause of maternal mortality, early identification of factors leading to haemorrhage and early management of underlying pathological process is the key stone of the treatment. The most important pregnancy related condition leading to bleeding with high maternal mortality and morbidity rate is disseminated intravascular coagulation (DIC).

Methods: A prospective study of 50 cases of pregnancy with DIC was performed from May 2018 to November 2020 in our institute to detect the various aetiology and complications associated with DIC leading to maternal mortality and morbidity and study perinatal outcome in pregnant women with DIC.

Results: The prevalence of DIC in our institute is 0.22%. Common causes of DIC were abruption (36%), haemorrhage (34%), preeclampsia (18%), sepsis (6%) and acute hepatic failure (6%). The composite severe maternal morbidity outcome in haemorrhage (100%), abruption (63%), preeclampsia (58%), and AVH (33%).Out of the three most common causes (abruption, haemorrhage and preeclampsia), the composite maternal morbidity outcome was significantly more in women with haemorrhage than with abruption and preeclampsia.

Conclusions: DIC, as a marker of severe obstetrical complications, is associated with high levels of mortality and morbidity. Recognition of the antecedent causes and early investigation for and active management of DIC may help lower this morbidity.

References

Williams J, Mozurkewich E, Chilimigras J, Van De Ven C. Critical care in obstetrics: pregnancy-specific conditions. Best Pract Res Clin Obstet Gynaecol. 2008;22(5):825-46.

Edmonds K, ed. Dewhurst’s Textbook of Obstetrics and Gynaecology for Postgraduates. 5th edn. Wiley Blackwell; 1995:42.

Physiological changes during pregnancy. In: Sharma JB, ed. Textbook of obstetrics 2nd edn. APC Books; 2020:51.

DeLee JB. A case of fatal hemorrhagic diathesis, with premature detachment of the placenta. Am J Obstet Dis Women Child. 1901;44:785-92.

Kumar V, Abbas AK, Fauso N, Aster JC, eds. Robbins and Cotran pathologic basis of disease. 8th edn. Saunders, Philadelphia, PA; 2010:639-675.

Taylor Jr FB, Toh CH, Hoots KW, Wada H, Levi M. Towards definition, clinical and laboratory criteria, and a scoring system for disseminated intravascular coagulation. Thrombos Haemostas. 2001;86(11):1327-30.

Bick RL. Disseminated intravascular coagulation current concepts of etiology, pathophysiology, diagnosis, and treatment. Hematol Oncol Clin North Am. 2003;17:149-76.

Bick RL. Syndromes of disseminated intravascular coagulation in obstetrics, pregnancy, and gynecology. Objective criteria for diagnosis and management. Hematol Oncol Clin North Am. 2000;14:999-1044.

Kobayashi T, Terao T, Maki M, Ikenoue T. Diagnosis and management of acute obstetrical DIC. Semin Thrombos Hemostat. 2001;27:161.

Cunningham F, Lenovo K, Bloom S, Hauth J, Rouse D, Spong C, eds. Williams obstetrics. 23rd edn. New York NY: McGraw Hill; 2010:706-756.

Mehta P, Vaishnav U, Pawar M, Disseminated intravascular coagulation in obstetrics: a retrospective study. Int J Health Sci Res. 2016; 6(7):94-8.

Cunningham FG, Nelson DB. Disseminated intravascular coagulation syndromes in obstetrics. Obstet Gynecol. 2015;126(5):999-1011.

Bick RL, Adams T. Disseminated intravascular coagulation: etiology, pathophysiology, diagnosis and management. Med Counterpoint. 1974;6:38.

Rattray DD, O’Connell CM, Baskett TF. Acute disseminated intravascular coagulation in obstetrics: a tertiary centre population review (1980 to 2009). J Obstet Gynaecol Can. 2012;34(4):341-7.

Attar S, Boyd D, Layne E, McLaughlin JO, Mansberger AR, Cowley RA. Alterations in coagulation and fibrinolytic mechanisms in acute trauma. J Trauma Acute Care Surg. 1969;9(11):939-65.

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Published

2021-10-27

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Original Research Articles