Disseminated intravascular coagulation in pregnancy: a case report

Aneetta M. Lalu; Rachel Mathew

doi:10.18203/2320-1770.ijrcog20252761

Authors

Aneetta M. Lalu Department of Obstetrics and Gynaecology, Pushpagiri Institute of Medical Sciences and Research Centre, Tiruvalla, Kerala, India
Rachel Mathew Department of Obstetrics and Gynaecology, Pushpagiri Institute of Medical Sciences and Research Centre, Tiruvalla, Kerala, India

DOI:

https://doi.org/10.18203/2320-1770.ijrcog20252761

Keywords:

DIC, Pregnancy, Maternal mortality

Abstract

Disseminated intravascular coagulation (DIC) is a life-threatening situation arising from a variety of obstetrical and non-obstetrical causes. Obstetrical causes include postpartum hemorrhage, placental abruption, preeclampsia, HELLP (hemolysis, elevated liver enzymes and low platelets) syndrome, retained stillbirth, septic abortion and intrauterine infection, amniotic fluid embolism and acute fatty liver of pregnancy. Prompt diagnosis and understanding of the underlying mechanism is essential for a favorable outcome. We report a successful pregnancy outcome in a multiparous woman with severe atonic postpartum hemorrhage following normal vaginal delivery managed by obstetric hysterectomy complicated with disseminated intravascular coagulation. Massive blood and blood products transfusion given. Serial monitoring of coagulation profile done- improved on postoperative day 3. Identification of risks and early diagnosis of DIC can prevent maternal morbidity and mortality. Team work and prompt treatment are essential for successful management.

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References

Erez O, Othman M, Rabinovich A, Leron E, Gotsch F, Thachil J. DIC in Pregnancy – Pathophysiology, Clinical Characteristics, Diagnostic Scores, and Treatments. J Blood Med. 2022;13:21-44. DOI: https://doi.org/10.2147/JBM.S273047

Bhattacharyya RK, Baruah R, Baruah D. Disseminated intravascular coagulation in obstetrics. J Obstet Gynaecol Barpeta. 2014;1(2):78-84.

Kenny LC, Mccrae KR, Cunningham FG. Chapter 17 - Platelets, Coagulation, and the Liver. In: Taylor RN, Roberts JM, Cunningham FG, Lindheimer MD, editors. Chesley’s Hypertensive Disorders in Pregnancy (Fourth Edition). San Diego: Academic Press. 2015;379-96. DOI: https://doi.org/10.1016/B978-0-12-407866-6.00017-1

Reese JA, Peck JD, Deschamps DR, McIntosh JJ, Knudtson EJ, Terrell DR, et al. Platelet Counts during Pregnancy. N Engl J Med. 2018;379(1):32-43. DOI: https://doi.org/10.1056/NEJMoa1802897

Creanga AA, Berg CJ, Syverson C, Seed K, Bruce FC, Callaghan WM. Pregnancy-Related Mortality in the United States, 2006–2010. Obstet Gynecol. 2015;125(1):5-12. DOI: https://doi.org/10.1097/AOG.0000000000000564

British Committee for Standards in Haematology, Stainsby D, MacLennan S, Thomas D, Isaac J, Hamilton PJ. Guidelines on the management of massive blood loss. Br J Haematol. 2006;135(5):634-41. DOI: https://doi.org/10.1111/j.1365-2141.2006.06355.x

ISTH DIC Score. ISTH DIC Scoring Algorithm: Modifications for use in Pregnancy. Available at: https://practical-haemostasis.com/Clinical%20 Prediction%20Scores/Formulae%20code%20and%20formulae/Formulae/DIC/isth_dic_pregnancy_score.html. Accessed on 12 April 2025.

Cunningham FG, Leveno KJ, Bloom SL, Dashe JS, Hoffman BL, Casey BM, et al. Williams Obstetrics. 25th edition. New York: McGraw Hill. 2018.

McLintock C, James AH. Obstetric hemorrhage. J Thromb Haemost. 2011;9(8):1441-51. DOI: https://doi.org/10.1111/j.1538-7836.2011.04398.x

Erez O, Novack L, Beer-Weisel R, Dukler D, Press F, Hadar E. DIC score in pregnant women – a population-based modification of the ISTH score. PLoS One. 2014;9(4):e93240. DOI: https://doi.org/10.1371/journal.pone.0093240

WOMAN Trial Collaborators. Effect of early tranexamic acid administration on mortality, hysterectomy, and other morbidities in women with postpartum haemorrhage (WOMAN): an international, randomised, double-blind, placebo-controlled trial. Lancet. 2017;389(10084):2105-16. DOI: https://doi.org/10.1016/S0140-6736(17)30638-4

Levi M. Disseminated intravascular coagulation: what’s new? Crit Care Clin. 2005;21(3):449-67. DOI: https://doi.org/10.1016/j.ccc.2005.02.001

Gizzo S, Patrelli TS, Saccardi C, Noventa M, Di Gangi S, Nardelli GB. Women’s blood: is obstetric hemorrhage still a leading cause of maternal mortality? Gynecol Endocrinol. 2013;29(7):638-41.

Shankaran S, Lester B. Postpartum hemorrhage and coagulopathy. Clin Obstet Gynecol. 2010;53(1):180-9.

Ahmed S, Siddiqui I, Jafri SA. Role of thromboelastography in obstetric practice: a review. J Pak Med Assoc. 2020;70(6):1086-90.