Disseminated intravascular coagulation in pregnancy: insights in pathophysiology, diagnosis and management

• Published in: American journal of obstetrics and gynecology Vol. 213; no. 4; pp. 452 - 463
• Main Authors: Erez, Offer, MD, Mastrolia, Salvatore Andrea, MD, Thachil, Jecko, MD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.10.2015
• Subjects: Abortion, Septic - physiopathology; Abruptio Placentae - physiopathology; acute fatty liver of pregnancy; Disseminated Intravascular Coagulation - diagnosis; Disseminated Intravascular Coagulation - physiopathology; Disseminated Intravascular Coagulation - therapy; Eclampsia - physiopathology; endothelial dysfunction; Fatty Liver - physiopathology; Female; Fetus; HELLP Syndrome - physiopathology; hemolysis, elevated liver enzymes, and low platelet count (HELLP) syndrome; hemorrhage; Humans; Obstetrics and Gynecology; Postpartum Hemorrhage - physiopathology; Pre-Eclampsia - physiopathology; Pregnancy; Pregnancy Complications - physiopathology; Pregnancy Complications, Hematologic - diagnosis; Pregnancy Complications, Hematologic - physiopathology; Pregnancy Complications, Hematologic - therapy; score; Stillbirth; trophoblast; Uterine Hemorrhage - physiopathology; Uterine Rupture - physiopathology; score; hemolysis, elevated liver enzymes, and low platelet count (HELLP) syndrome; trophoblast; endothelial dysfunction; acute fatty liver of pregnancy; hemorrhage
• ISSN: 0002-9378; 1097-6868
• DOI: 10.1016/j.ajog.2015.03.054

Disseminated intravascular coagulation (DIC) is a life-threatening situation that can arise from a variety of obstetrical and nonobstetrical causes. Obstetrical DIC has been associated with a series of pregnancy complications including the following: (1) acute peripartum hemorrhage (uterine atony, cervical and vaginal lacerations, and uterine rupture); (2) placental abruption; (3) preeclampsia/eclampsia/hemolysis, elevated liver enzymes, and low platelet count syndrome; (4) retained stillbirth; (5) septic abortion and intrauterine infection; (6) amniotic fluid embolism; and (7) acute fatty liver of pregnancy. Prompt diagnosis and understanding of the underlying mechanisms of disease leading to this complication in essential for a favorable outcome. In recent years, novel diagnostic scores and treatment modalities along with bedside point-of-care tests were developed and may assist the clinician in the diagnosis and management of DIC. Team work and prompt treatment are essential for the successful management of patients with DIC.