Successful recovery from disseminated intravascular coagulation in a patient with abruptio placentae who presented for emergency lower-segment cesarean section

Abstract

Healthy pregnancy is accompanied by changes in the hemostatic system that convert it into a hypercoagulable state vulnerable to a spectrum of disorders ranging from venous thromboembolism to disseminated intravascular coagulation (DIC). DIC is always a secondary phenomenon triggered by specific disorders such as abruption placentae and amniotic fluid embolism due to intravascular release of thromboplastin or endothelial damage resulting from pre-eclampsia and sepsis. Delivery of the fetus and placenta in the early stage of accelerated disease progression is the definitive therapy. Uncompensated DIC, associated with pre-eclampsia, is monitored with serial hematological investigation of platelet count, fibrin degradation products, and serum fibrinogen level. Removal of triggering mechanisms with supportive measures associated with or without mechanical ventilator support is key to successful management. Outcome depends on our ability to deal with the triggers primarily and not only on correcting coagulation and providing mechanical ventilatory therapy.