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

Am J Obstet Gynecol. 2015 Oct;213(4):452-63. doi: 10.1016/j.ajog.2015.03.054. Epub 2015 Mar 31.

Abstract

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.

Keywords: acute fatty liver of pregnancy; endothelial dysfunction; hemolysis, elevated liver enzymes, and low platelet count (HELLP) syndrome; hemorrhage; score; trophoblast.

Publication types

  • Review

MeSH terms

  • Abortion, Septic / physiopathology
  • Abruptio Placentae / physiopathology
  • Disseminated Intravascular Coagulation / diagnosis
  • Disseminated Intravascular Coagulation / physiopathology*
  • Disseminated Intravascular Coagulation / therapy
  • Eclampsia / physiopathology
  • Fatty Liver / physiopathology
  • Female
  • Fetus
  • HELLP Syndrome / physiopathology
  • Humans
  • Postpartum Hemorrhage / physiopathology
  • Pre-Eclampsia / physiopathology
  • Pregnancy
  • Pregnancy Complications / physiopathology
  • Pregnancy Complications, Hematologic / diagnosis
  • Pregnancy Complications, Hematologic / physiopathology*
  • Pregnancy Complications, Hematologic / therapy
  • Stillbirth
  • Uterine Hemorrhage / physiopathology
  • Uterine Rupture / physiopathology

Supplementary concepts

  • Acute fatty liver of pregnancy