Disseminated intravascular coagulation (DIC) refers to the breakdown of normal blood clotting capacity.
Disseminated intravascular coagulation or DIC is also sometimes referred to as “consumptive coagulopathy,” referring to the potentially fatal constellation of factors which can lead to uncontrolled hemorrhage, shock and maternal or fetal death.
Although pregnancy typically induces what is characterized as a “hypercoaguable state,” it has long been recognized that several conditions can predispose a patient to the development of disseminated intravascular coagulation or DIC.
Placental abruption, the premature separation of the placenta from the uterus, is generally considered one of the more common causes of the development of disseminated intravascular coagulation or DIC during pregnancy.
Additionally, a mother who suffers a fetal death in utero, whether associated with a placental abruption or not, is at especially high risk for the development of disseminated intravascular coagulation, especially in those cases where the delivery of the deceased baby is delayed.
For this reason, the death of one baby in a twin or other multi-fetal pregnancy presents a grave risk for the development of disseminated intravascular coagulation where delivery is delayed, thereby threatening the survival of the living baby or babies.
Many patients with pre-eclampsia or HELLP Syndrome are also at particularly high risk for the development of disseminated intravascular coagulation.
Patients who are at risk for the development of disseminated intravascular coagulation require close and careful obstetrical management.
In many cases, safe and careful obstetricians refer their patients who are at risk for developing disseminated intravascular coagulation to maternal-fetal specialists, doctors who are specifically trained in managing the pregnancies of patients who are at risk for developing disseminated intravascular coagulation.
Monitoring of at risk patients will typically include serial blood laboratory studies to assess any changes in those clotting factors which may evidence coagulation disorders.
Such tests will typically include evaluations of platelet counts, fibrinogen, prothrombin and partial thromboblastin times.
With the diagnosis of acute disseminated intravascular coagulation, safe and careful obstetricians will initiate aggressive management. Massive hemorrhage associated with disseminated intravascular coagulation can quickly lead to hypovolemic shock, resulting in the loss of oxygenated blood flow in both the mother and the baby.
Accordingly, safe and careful obstetricians will typically deliver their patients as expeditiously as possible if the mother’s condition can be stabilized.
In cases of acute hemorrhage where the mother is at risk for developing hypovolemic shock, fluids and red blood cells will typically be transfused to help restore tissue perfusion and oxygen carrying capacity.
Platelets and other clotting factors will also typically be administered.
The development of disseminated intravascular coagulation or DIC represents a potentially dire obstetrical emergency, placing both the life of the mother and her baby at risk.