Disseminated intravascular coagulation (DIC) is a pathologic disruption of the finely-balanced process of hemostasis. Massive activation of the clotting cascade results in widespread thrombosis, which leads to depletion of platelets and coagulation factors and excessive thrombolysis. The end result is multiorgan failure and hemorrhage.
In a study of discharge coding data from the United States Nationwide Inpatient Sample (NIS), the prevalence of DIC related to pregnancy increased by 35.5 percent between 1998 and 2009, from 9.2 to 12.5 per 10,000 delivery hospitalizations, and DIC accounted for approximately one-quarter of maternal deaths during that period . Peripartum hemorrhage is a common cause of DIC in pregnant women. It is estimated to account for 1 to 5 percent of all cases of DIC in high-resource countries, and an even higher proportion of DIC cases in low-resource countries .
Any patient in DIC presents a major management challenge, and this challenge is further complicated when the mother is carrying a viable fetus. For example, delaying delivery to transfuse the mother in DIC may not be in the best interest of a fetus with a nonreassuring fetal heart rate (FHR) tracing, whereas performing an emergency cesarean delivery on a mother in DIC may not be in her best interest. Even in the setting of fetal demise, labor and delivery of a woman in DIC carries the potential for catastrophic hemorrhage.
This topic will focus upon DIC related to pregnancy. Broader discussions of the pathogenesis, clinical manifestations, diagnosis, and treatment of DIC can be found separately.
PREGNANCY COMPLICATIONS THAT MAY LEAD TO DIC
The most common pregnancy complications that may lead to disseminated intravascular coagulation (DIC) are :