Overt Disseminated Intravascular Coagulation in Obstetric Patients
Ounjai Kor-anantakul MD*, Arnuparp Lekhakula MD**
Affiliation : * Department of Obstetrics and Gynecology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkla ** Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkla
Objective : To determine the incidence, etiology and outcome of treatment in obstetric patients complicated by
overt disseminated intravascular coagulation (DIC).
Materials and Methods : 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 1 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%), amni-
otic fluid embolism in 4 (16%), acute fatty liver of pregnancy (AFLP) in 4 (16%), and HELLP syndrome in 3
(12%). A definite diagnosis of DIC 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.
Keywords : Disseminated intravascular coagulation, Pregnancy, Etiology, Treatment, Outcome
