Diagnosis and treatment of coagulopathy secondary to single fetal demise in twin pregnancy

Abstract

Introduction: Disseminated intravascular coagulation following single fetal demise in a twin pregnancy is a rare event. As such, the diagnosis and management of such cases are complicated and require the assistance of various laboratory tests. Case: 26 years old patient, carrying dichorionic diamniotic twin pregnancy was complicated by single fetal demise at 21+6 weeks and preterm premature rupture of membranes (PPROM) at 24+5 weeks. Pregnancy was managed conservatively until 30+4 weeks gestation when abnormal laboratory tests including dysfibrinogenemia and pathological thromboelastogram (TEG) indicated the development of disseminated intravascular coagulopathy (DIC) while the patient remained asymptomatic. A multidisciplinary team decided on prompt delivery by cesarean section. Cesarean delivery (CD) was uneventful, yet post-operative course was complicated by worsening laboratory tests and post-partum hemorrhage that were treated by uterotonics and blood products resulting in clinical and laboratory normalization. Conclusion: DIC following single fetal demise in a twin pregnancy is rare. A new laboratory test, TEG, may aid in diagnosis and management of DIC. Keywords: Twins, Disseminated intravascular coagulation (DIC), Intrauterine fetal demise (IUFD), Thromboelastogram (TEG), Coagulopathy.