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Disseminated intravascular coagulation during pregnancy

Susan M Ramin, MD
Section Editors
Charles J Lockwood, MD, MHCM
David L Hepner, MD
Steven Kleinman, MD
Lawrence LK Leung, MD
Deputy Editors
Vanessa A Barss, MD, FACOG
Jennifer S Tirnauer, MD


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. This can result in hemorrhage, thrombosis, and/or multiorgan failure.

Any patient with DIC presents a major management challenge, and this challenge is further complicated when the patient is carrying a viable fetus. For example, delaying delivery to transfuse a pregnant woman with DIC who is bleeding heavily may not be in the best interest of a fetus with a category III fetal heart rate tracing, whereas performing an emergency cesarean delivery on a pregnant woman with DIC may not be in her best interest. Even in the setting of fetal demise, labor and delivery of a pregnant woman with 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. (See "Clinical features, diagnosis, and treatment of disseminated intravascular coagulation in adults".)

Other causes of pregnancy-associated thrombocytopenia and obstetrical hemorrhage are also presented separately. (See "Thrombocytopenia in pregnancy" and "Overview of the etiology and evaluation of vaginal bleeding in pregnant women".)


The prevalence of DIC in pregnancy ranges from 0.03 to 0.35 percent in population-based studies [1-3], or 12.5 per 10,000 delivery hospitalizations in one study [1]. Although the overall prevalence of DIC is low in pregnancy, the frequency of DIC in women with specific pregnancy complications can be quite high. In a review of 53 cases of amniotic fluid embolism, DIC was observed in approximately two-thirds, and in a series of 442 pregnancies complicated by hemolysis, elevated liver function tests, and low platelets (HELLP syndrome), 92 had DIC (21 percent), the majority were associated with abruptio placentae [4,5].

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Literature review current through: Oct 2017. | This topic last updated: Jan 27, 2016.
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