Overt disseminated intravascular coagulation in obstetric patients.

OBJECTIVE

To determine the incidence, etiology and outcome of treatment in obstetric patients complicated by overt disseminated intravascular coagulation (DIC).

MATERIAL AND METHOD

Medical records of 25 obstetric patients with a diagnosis of DIC in Songklanagarind University Hospital from January 1993 to December 2005 were reviewed

RESULTS

The incidence of overt DIC was I per 1,355 deliveries. Median maternal age was 30 years (range 17-44 years). Median duration of hospital stay was 10 days (range 0-32 days). The main associated conditions included abruptio placentae in 6 patients (24%), pregnancy-induced hypertension (PIH) in 5 (20%), amniotic fluid embolism in 4 (16%), acute fatty liver of pregnancy (AFLP) in 4 (16%), and HELLP syndrome in 3 (12%). A definite diagnosis ofDIC was made in 8 patients (32%) with a median DIC score of 6 (range 5-7) and the remainder were clinically diagnosed with incomplete work-up. All patients received blood component replacement. Cesarean section was performed in 10 patients (40%) and hysterectomy in 9 patients (36%). Six patients died, giving a case mortality rate of 24%. Three were associated with amniotic fluid embolism and one of each with fulminant hepatitis, ALFP and HELLP syndrome. Thirteen of 24 fetuses (54%) died, most related to abruptio placentae (6/6, 100%), PIH (4/5, 80%), and amniotic fluid embolism (2/4, 50%).

CONCLUSION

Various pregnancy-related conditions will predispose to DIC development. Early diagnosis with prompt treatment, including a quick decision for surgical intervention, and eradication of predisposing conditions would minimize maternal morbidity and mortality.