Obstetrical Disseminated Intravascular Coagulation Research Articles

Risk Assessment of Critical Obstetric Bleeding With Low-Molecular-Weight Heparin.

Use of unfractionated heparin (UFH) during the peripartum period is considered to be a higher risk of critical obstetric bleeding compared to low-molecular-weight heparin (LMWH). However, the evidence for the safety of using LMWH during the peripartum period is currently lacking. This study retrospectively investigated a nationwide medical database to clarify the safety of using LMWH during childbirth. The Japanese Nationwide Diagnosis Procedure Combination database was retrospectively reviewed, and data from women with childbirth between 2018 and 2022 were collected. Among the overall 354,299 women with childbirth, 3,099 were with obstetric disseminated intravascular coagulation (DIC), 484 were with critical obstetric bleeding requiring massive red blood cell (RBC) transfusion ≥4,000 cc, and 38 were with maternal death. Among the overall women, each of the anticoagulants other than LMWH was associated with critical obstetrical bleeding with an adjusted odds ratio (aOR) greater than 1.0, while LMWH was not associated with critical obstetrical bleeding (aOR, 0.54 (95% confidence interval, 0.11-2.71)). This finding did not change in subgroup analyses among those with Cesarean section. Furthermore, UFH was associated with critical bleeding among the 3,099 women with obstetrical DIC (aOR, 3.91 (2.83-5.46)), while LMWH was not (aOR, 0.26 (0.03-1.37)). The use of UFH was significantly associated with an increased critical obstetric hemorrhage requiring massive RBC transfusion or total hysterectomy. Meanwhile, the use of LMWH was not associated with increased critical obstetric bleeding. LMWH would be safer than UFH to be used for women during childbirth.

Differences between Japanese new criteria and pregnancy-specific modified ISTH DIC scores for obstetrical DIC diagnosis.

The new Japanese diagnostic criteria for obstetrical disseminated intravascular coagulation (DIC) (tentative version) were released in June 2022. We aimed to demonstrate the differences in characteristics between women with DIC diagnosed using the new Japanese criteria and those diagnosed using the pregnancy-specific modified International Society on Thrombosis and Hemostasis DIC score, also known as the pregnancy-specific modified ISTH DIC score, which was released in 2014. In this retrospective cohort study, all participants were retrospectively diagnosed based on both criteria. Six women were diagnosed with obstetrical DIC based on both criteria (Group A). Of the 43 women diagnosed with obstetrical DIC based on the worldwide criteria, 36 were diagnosed with non-obstetrical DIC based on the new Japanese criteria (Group B). Group A had significantly lower fibrinogen levels and significantly higher prothrombin time differences and scores of underlying diseases (particularly postpartum hemorrhage with coagulopathy) and laboratory findings than Group B. Additionally, Group A had significantly higher rates of platelet concentrate (PC) transfusion therapy for obstetrical DIC and more transfusions of fresh frozen plasma and/or cryoprecipitate, red blood cells and PC than Group B. Thus, the new Japanese criteria detected more severe cases of obstetrical DIC compared with the worldwide criteria.

Coagularea intravasculară diseminată în obstetrică: mini-review

Disseminated intravascular coagulation (DIC) represents a major challenge in obstetrics. The prognosis is influenced by the severity of the coagulopathy and its underlying condition. Early recognition of DIC, if possible, is important because of the potential for end-organ microvascular thrombosis and/or major blood loss. Obstetric DIC manifests mainly with bleeding. In order to facilitate the diagnosis and management of disseminated intravascular coagulation, a pregnancy-specific DIC score was developed. The therapy aims at treating the condition that triggers DIC, the hemorrhagic complications and the coagulopathy.

The Efficacy of Transarterial Embolization for Postpartum Hemorrhage Complicated with Disseminated Intravascular Coagulation: A Single-Center Experience.

Indications for the use of transarterial embolization (TAE) for postpartum hemorrhage (PPH) have been established. However, the efficacy of TAE for PPH complicated by disseminated intravascular coagulation (DIC) remains controversial. In this study, we investigated the efficacy of TAE for PPH complicated by DIC. A database review was conducted to identify patients who were treated with TAE for PPH at our hospital. TAE was performed in 41 patients during the study period. Effective hemostasis was achieved in all cases, but additional procedures, such as re-embolization or hysterectomy, were required in five patients (12.2%). The typical causes of PPH included uterine atony (18 cases), placenta previa (15 cases), amniotic fluid embolism (DIC-type) (11 cases), and placenta accreta spectrum (10 cases). The mean blood loss was 3836 mL. The mean obstetrical DIC and the International Society on Thrombosis and Hemostasis DIC scores were 7.9 and 2.6, respectively. The efficacy of hemostasis was comparable between patients with and without DIC. However, the complete success rate of TAE was lower in patients with DIC as the condition worsened than that in non-DIC patients. Overall, TAE is effective as a minimally invasive treatment for PPH complicated by DIC.

Capacity of Japanese institutions to manage obstetrical disseminated intravascular coagulation in 2018: A national surveillance questionnaire and retrospective cohort study.

To investigate the management of obstetrical disseminated intravascular coagulation (DIC) in Japan. We sent a surveillance questionnaire to 2299 institutions to collect details about the deliveries they performed in 2018. We investigated differences in the management of obstetrical DIC among three types of institutions: perinatal medical centers (PMCs), general hospitals with obstetrical facilities (GHs), and maternal clinics with beds (MCs). We received responses from 703 institutions (30.6% of the total mailed) with results of 306 799 women who gave birth in 2018. In Japan, the potential to treat postpartum hemorrhage and obstetrical DIC was high in the PMC group, moderate in the GH group, and low in the MC group. The incidence of obstetrical DIC in the PMC group (0.44%) was significantly higher than that in the GH (0.21%) and MC (0.06%) groups. The mortality of women with obstetrical DIC in PMCs (1.3%) was similar to that in GHs (0.6%) and MCs (0.0%). The percentages of PMCs that always or sometimes transfused fresh frozen plasma or fibrinogen concentrates (100% and 42.2%, respectively) were significantly higher than those in the GH (88.2% and 29.5%, respectively) and MC groups (29.4% and 5.3%, respectively). Furthermore, institutions whose internal protocols mandated that replacement therapy be always administered in women with obstetrical DIC scores of ≥8 had similar protocols to those for women with fibrinogen levels of ≤1.5g/L. The capacity to provide therapy for postpartum hemorrhage and obstetrical DIC varied widely among the three groups of institutions.

Effect of hypofibrinogenemia on obstetrical disseminated intravascular coagulation in Japan in 2018: a multicenter retrospective cohort study.

Japanese obstetrical hemorrhage recommendations state that not only pregnant women with an obstetrical disseminated intravascular coagulation (DIC) score ≥ 8 points but also those with fibrinogen levels ≤ 1.5g/L have a high risk of maternal death and warrant blood transfusion. Our aim was to demonstrate the potential of fibrinogen levels ≤ 1.5g/L as predictors of a Japanese obstetrical DIC score of ≥ 8. We included 595 participants with blood loss ≥ 1000mL during vaginal delivery or ≥ 2000mL during cesarean delivery. The frequency and volume of red blood cell (RBC), fresh-frozen plasma, platelet concentrate (PC), and fibrinogen administration in women with a DIC score of ≥ 8 and fibrinogen levels of ≤ 1.5g/L were significantly higher than controls (P < 0.0001). Multivariate analysis demonstrated that a score of ≥ 3 was associated with RBC or fibrinogen administration and a score of ≥ 5 was associated with PC transfusion. Fibrinogen levels ≤ 1.89g/L and ≤ 2.44g/L were associated with PC transfusion and fibrinogen administration, respectively. Fibrinogen levels ≤ 1.5g/L may have similar potential to a DIC score of ≥ 8 points for detecting obstetrical DIC in Japan.

The value of the portable fibrinogen measuring device\u2014a case report of severe postpartum hemorrhage with obstetric disseminated intravascular coagulation

BackgroundFibrinogen concentration is an important indicator of the treatment for obstetric disseminated intravascular coagulation (DIC). We present how using the fibrinogen measuring device could solve problems in the treatment of postpartum hemorrhage with complicated DIC.Case presentationA 32-year-old woman with monochorionic diamniotic twins at 22 weeks of pregnancy was diagnosed with placental abruption and underwent emergent cesarean section. The estimated blood loss was 8375 g. She was transferred to our hospital for further treatment. Compressive uterine sutures and balloon tamponade were performed. We transfused fibrinogen and fresh frozen plasma actively during the operation to maintain plasma fibrinogen above 200 mg/dL by using a point-of-care fibrinogen measuring device. In spite of massive hemorrhage exceeding 10 L, she was extubated at the end of the operation and discharged on the 7th day after the operation.ConclusionThe portable fibrinogen measuring device was useful for point-of-care assessment of obstetric DIC.

Clinical results of transarterial embolization for post-partum hemorrhage in 62 patients.

The pathology of post-partum hemorrhage (PPH) differs depending on its cause, background and timing of bleeding, and the effectiveness of transarterial embolization (TAE) is thought to vary based on these characteristics. The aim of this study is to evaluate the treatment outcomes of TAE for PPH. Technical success, initial clinical success (hemostasis without repeat TAE or surgical treatment after initial TAE) and final clinical success (hemostasis with or without repeat TAE, but without surgical treatment) were assessed in 62 Japanese patients. Factors affecting final clinical success were analyzed using univariate analysis. Values of P < 0.05 were considered statistically significant. Further, the clinical course and factors associated with rebleeding, return of menstruation and fertility, and complications of TAE were assessed. Final clinical success rate was significantly lower in cases with obstetrical disseminated intravascular coagulation (DIC) or the International Society on Thrombosis and Hemostasis (ISTH) DIC (P = 0.01, 0.03). Rebleeding (n = 9, 14.5%) was more common in patients with retained products of conception (RPOC) (P = 0.006). On long-term follow-up in 23 patients, return of menstruation was confirmed in 17 (73.9%) of these patients. Subsequent pregnancy was confirmed in seven patients (30.4%). TAE-related complications were seen in 6 patients (9.0%). There were no maternal deaths. Obstetrical and ISTH DIC reduced the success rate of TAE for PPH (P = 0.01, 0.03). Rebleeding, which is observed significantly more frequently in PPH caused by RPOC (P = 0.006), can be effectively treated by repeat TAE.

The Most Important Factors in Prognosis Of Obstetric Patients with Disseminated Intravascular Coagulation: A Tertiary Center Study

Objective: The aim of this study was to investigate the underlying causes of obstetrical disseminated intravascular coagulation (DIC) and to evaluate the laboratory and clinical signs affecting DIC-related morbidity and mortality in women diagnosed with obstetrical DIC in a tertiary referral hospital.&#x0D; Method: The retrospective study included women with DIC who either had a delivery at Dicle University Medical School Gynecology and Obstetrics Department or were referred to this department prior to delivery between May 2006 and May 2016. DIC scoring was performed using the DIC scoring system developed by the International Society of Thrombosis and Hemostasis (ISTH) in 2001.&#x0D; Results: A total of 82 women with obstetrical DIC were included in the study. The incidence of obstetrical DIC in our department was 0.41%. Overall mortality rate was 24% and mortality occurred in 8% of the patients with a DIC score of ≤5 and in 12% of the patients with a score of &gt;5 (p=0.043). Multiple logistic regression analysis indicated that increased INR (International Normalized Ratio) and ALT (Alanin Aminotransferaz) levels led to a significant increase in DIC-related mortality [OR: 1.803 (CI: 1.027-3.167), OR: 1.003 (CI: 1.001-1.005), respectively].&#x0D; Conclusions: Obstetrical DIC may result in high mortality and morbidity. DIC scoring can be useful for predicting the prognosis and DIC-related mortality. INR and ALT is the most important laboratory parameter in DIC and also can affect mortality.

74. The prognostic role of the plasma antithrombin level in patients with obstetric DIC induced by placental abruption

Introduction In patients with disseminated intravascular coagulation (DIC), the processes of coagulation and fibrinolysis continue with consumption of coagulation inhibitors. The plasma antithrombin (AT) level is a powerful prognostic marker of DIC related to sepsis, malignancy, and liver disease. However, no previous studies had addressed the prognostic role of the AT level in patients with obstetric DIC. Objectives To investigate whether the plasma AT level has a prognostic role to predict the prognosis of patients with obstetric DIC. Methods We conducted a single-center, retrospective cohort study from January 2007 to August 2016. Patients with obstetric DIC induced by placental abruption were eligible for this study. Obstetric DIC was diagnosed as a score of ⩾8, based on the obstetric DIC score approved by the Japanese Society of Obstetrics and Gynecology. We collected data pertaining to baseline characteristics, and evaluated data to identify the following outcomes: incidence of organ damage and lowest serum AT activity level within 4 days after an obstetric DIC diagnosis. Results 29 patients were enrolled in this study and 8 patients developed organ damages. According to the receiver operating characteristic curve analyses, the calculated value of the area under the curves for the lowest AT activity predictive of organ damage was 0.777 (p = 0.023). At an AT activity cutoff point of 60.5%, the sensitivity was 90.5% and specificity was 62.5%. We assessed four possible confounders related to decreasing AT activity by logistic regression analysis: hypertensive disorders of pregnancy (HDP), Cesarean delivery, the volume of transfused FFP, the initial albumin level. Consequently, HDP and the volume of transfused FFP were identified as prognostic variables. Discussion As in other DIC, serum AT activity can be a prognostic marker in obstetric DIC: the incidence of organ damage increased when the AT activity was 60.5% or less.

157. The efficacy of recombinant human soluble thrombomodulin in preeclampsia

Introduction Recombinant human soluble thrombomodulin (rhTM) is a novel anti-coagulant agent that regulates the imbalanced coagulation system by reducing the excessive activation of thrombin. rhTM potentially reduces the morbidity and mortality in patients with sepsis-induced disseminated intravascular coagulation (DIC). However, the efficacy of rhTM in obstetric DIC, especially in patients with preeclampsia, has not yet been established. Objectives We performed this study to examine whether the administration of rhTM was a potentially effective treatment for DIC and organ damage in preeclamptic patients. Methods This is a single-center, retrospective cohort study conducted between January 2007 and December 2017 using the records of our hospital. The eligibility criteria were known or suspected obstetric DIC documented on the basis of clinical and laboratory data. Baseline imbalance between patients with and without treatment of rhTM was adjusted using an inverse probability of treatment weighting using propensity scores composed of the following independent variables: initial platelet counts, D-dimer levels, fibrinogen levels, and prothrombin time–international normalized ratio. We evaluated laboratory changes and clinical outcomes in the early phase of obstetric DIC in preeclampsia patients. Results In total, 21 patients admitted to our department during the study period fulfilled the required criteria; of these, 10 and 11 patients were included in the rhTM and control group, respectively. After adjustment, treatment with rhTM was associated with significant improvements in platelet counts (p = 0.036), D-dimer levels (p = 0.009), compared with the control group. Serum creatinine level was significantly improved in rhTM group (p = 0.036), but other laboratory data of organ damage and failure showed no significant difference between the two groups. Discussion rhTM administration was associated with clinical and laboratory improvement in patients with DIC caused by underlying obstetric conditions in patient with preeclampsia. Further clinical research is needed to clarify the optimal application of rhTM in patients with preeclampsia.

87. Recombinant human soluble thrombomodulin for obstetric disseminated intravascular coagulation

Introduction Disseminated intravascular coagulation (DIC) is a syndrome characterized by systemic activation of coagulation which results in widespread fibrin deposition and excessive consumptions of platelets and clotting factors. Recombinant human soluble thrombomodulin (rhTM) is a novel anticoagulant agent and reduces excessive thrombin generation and regulates imbalanced activation of coagulation systems. Although the efficacy of rhTM for obstetric DIC is still uncertain, it has been reported that rhTM reduces morbidity and mortality in sepsis-induced DIC patients. Objectives To examine whether rhTM administration could be effective for DIC patients induced by obstetric underlying disorders. Methods This study is a retrospective cohort study in a single perinatal medical center performed between January 2007 and December 2015. Eligibility criteria are obstetric DIC documented on the basis of clinical and laboratory data and association with one or more major underlying obstetric disorders. We evaluated both laboratory findings and clinical conditions at the early phase. Results Sixty-five patients (including 17 preeclampsia patients) admitted to our hospital fulfilled the criteria. Thirty-six were categorized as a rhTM group and twenty-nine were categorized as a control group. Age, delivery method and diagnosis were not different between groups. For details, amount of hemorrhage, laboratory parameters, DIC score and therapeutic intervention were not shown statistically meaningful. After adjusting two groups, treatment by rhTM was associated with significant improvements in platelet levels, D-dimer concentration, fibrinogen levels and PT-INR. The amounts of platelets transfused was significantly lower in a rhTM group (3.02 vs 6.03 units, P = 0.016). None of the adjusted group differences were statistically significant for all types of multiple organ failure. Discussion In DIC patients induced by obstetric underlying disorders, improvements of both clinical conditions and laboratory findings were confirmed in a rhTM group. Further clinical research is expected to clarify the optimal solution for administrating rhTM in obstetric DIC patients.

Surveillance of the safety and efficacy of recombinant human soluble thrombomodulin in patients with obstetrical disseminated intravascular coagulation

BackgroundRecombinant human soluble thrombomodulin (TM-α) has been shown to be useful in the treatment of disseminated intravascular coagulation (DIC) in a heparin-controlled study, and has been available for clinical use in Japan since 2008. However, use of TM-α for obstetrical DIC has not yet been established, so efficacy and safety were analyzed in 117 obstetrical DIC patients identified from post-marketing surveillance. Materials and methodsFrom June 2010 to March 2012, the cases of 117 patients with obstetrical DIC treated with TM-α were registered. ResultsIn the majority of cases, the underlying disease was DIC-type postpartum hemorrhage (n=43) or placental abruption (n=37). Mean (±standard deviation) obstetrical DIC score was 10.6±4.9. Mean duration of TM-α administration was 2.2±1.7days. The most commonly used concomitant anticoagulants were antithrombin (n=60) and gabexate mesilate (n=37). Concomitantly used blood components products included red blood cell concentrate (n=72), fresh frozen plasma (n=70), and platelet concentrate (n=31). Hemostatic test result profiles revealed significant improvement of fibrinogen/fibrin degradation products, D-dimer, fibrinogen, prothrombin time and activated partial thromboplastin time. Efficacies of TM-α as evaluated by “The efficacy evaluation criteria for DIC in obstetrics” at 24h, 48h and the day after last administration of TM-α were 72.3%, 82.4% and 90.2%, respectively. Total bleeding adverse drug reactions occurred in 6 patients (5.1%). ConclusionsThis surveillance confirmed the safety and efficacy of TM-α in clinical practice. These findings thus indicated that the efficacy of TM-α is comparable to that of previously investigated obstetrical DIC pharmacotherapies.

Emergent Uterine Arterial Embolization Using N-Butyl Cyanoacrylate in Postpartum Hemorrhage with Disseminated Intravascular Coagulation.

Although it is widely accepted that uterine artery embolization (UAE) is an effective therapeutic strategy for postpartum hemorrhage (PPH), no consensus has been reached regarding the efficacy of UAE in patients with PPH with disseminated intravascular coagulation (DIC). This single-center retrospective cohort study included patients treated with UAE using NBCA for PPH between 2010 and 2015. The patients were divided into DIC and non-DIC groups, according to the obstetrical DIC score and the overt DIC diagnostic criteria issued by the International Society of Thrombosis and Haemostasis (ISTH), and their clinical outcomes were compared. There were 28 patients treated with UAE using NBCA. Complete hemostasis was achieved by UAE in 19 of 28 patients. In eight of nine patients with unsuccessful hemostasis, surgical hemostatic interventions were performed after UAE, and hemostasis was achieved in seven patients. UAE using NBCA showed no significant intergroup differences in complete hemostasis according to the presence or absence of DIC based on obstetrical DIC score (70% versus 62.5%, P = 1.000) or ISTH DIC score (54.5% versus 76.5%, P = 0.409). UAE using NBCA may be a useful first-choice treatment for PPH with DIC.

The efficacy of recombinant human soluble thrombomodulin for obstetric disseminated intravascular coagulation: a retrospective study.

IntroductionRecombinant human soluble thrombomodulin (rhTM) is a novel anti-coagulant agent that regulates the imbalanced coagulation system by reducing the excessive activation of thrombin. rhTM potentially reduces the morbidity and mortality in patients with sepsis-induced disseminated intravascular coagulation (DIC). However, the efficacy of rhTM in obstetric DIC has not yet been established. We performed this study to examine whether the administration of rhTM was a potentially effective treatment for DIC induced by one or more underlying obstetric disorders.MethodsThis is a single-center, retrospective cohort study conducted between January 2007 and February 2015 using the records of the Department of Obstetrics at the Perinatal Medical Center of TOYOTA Memorial Hospital, Aichi, Japan. The eligibility criteria were known or suspected obstetric DIC documented on the basis of clinical and laboratory data and association with one or more major underlying obstetric disorders. Baseline imbalance between patients with and without treatment of rhTM was adjusted using an inverse probability of treatment weighting using propensity scores composed of the following independent variables: severe postpartum hemorrhage, placental abruption, and preeclampsia/eclampsia, including hemolysis, elevated liver enzymes, and low platelet syndrome, initial platelet counts, D-dimer levels, fibrinogen levels, and prothrombin time–international normalized ratio (PT–INR). We evaluated laboratory changes and clinical outcomes in the early phase of obstetric DIC.ResultsIn total, 66 of 4627 patients admitted to our department during the study period fulfilled the required criteria; of these, 37 and 29 patients were included in the rhTM and control group, respectively. After adjustment, treatment with rhTM was associated with significant improvements in platelet counts, D-dimer levels, fibrinogen levels, and PT–INR compared with the control group. The platelet concentrate transfusion volume was significantly lower in the rhTM treatment group (3.02 vs 6.03 units, P = 0.016). None of the adjusted group differences were statistically significant for all types of organ damage and failure.ConclusionrhTM administration was associated with clinical and laboratory improvement in patients with DIC caused by underlying obstetric conditions. Further clinical research is needed to clarify the optimal application of rhTM in each of the causative obstetric disorders.

A New Protocol for Determining Intervention with Trans-Catheter Arterial Embolization or Surgical Hemostasis for Obstetric Hemorrhage

Objectives: The aim of this study is to introduce protocols for choosing trans-arterial embolization (TAE) or surgical hemostasis as an initial therapy for obstetric hemorrhage. Materials and Methods: From 2002 to 2011 at our hospital, the medical records of the patients who underwent TAE or surgical hemostasis for obstetric hemorrhage were reviewed to assess the following data: The causes of obstetric hemorrhage, Shock Index (SI) and obstetrical disseminated intra-vascular coagulation (DIC) score, amount of bleeding, transfusion, and operation time. Results: Twenty-five patients underwent TAE and six underwent surgical hemostasis. SI and obstetrical DIC score of the TAE group were 1.0 (0.4 - 2.2) and 6.0 (1 - 32), respectively. They were significantly lower than those of the surgical hemostasis group (SI: 1.6, obstetrical DIC score: 12.5, p < 0.05). Though the hemorrhage could be controlled sufficiently in 23 cases of the TAE group, 5 cases went into shock during TAE. The SI and obstetrical DIC score of shock group were 1.2 (1 - 2) and 10 (2 - 32), respectively. Conclusion: Though TAE is a useful therapy to control obstetric inevitable hemorrhage, special attention should be paid to the vital signs during TAE, especially in cases where SI and/or obstetrical DIC score are higher than 1.2 and 10, respectively.

Obstetrical disseminated intravascular coagulation score.

Obstetrical disseminated intravascular coagulation (DIC) is usually a very acute, serious complication of pregnancy. The obstetrical DIC score helps with making a prompt diagnosis and starting treatment early. This DIC score, in which higher scores are given for clinical parameters rather than for laboratory parameters, has three components: (i) the underlying diseases; (ii) the clinical symptoms; and (iii) the laboratory findings (coagulation tests). It is justifiably appropriate to initiate therapy for DIC when the obstetrical DIC score reaches 8 points or more before obtaining the results of coagulation tests. Improvement of blood coagulation tests and clinical symptoms are essential to the efficacy evaluation for treatment after a diagnosis of obstetrical DIC. Therefore, the efficacy evaluation criteria for obstetrical DIC are also defined to enable follow-up of the clinical efficacy of DIC therapy.

Critical Care of Gynecological and Obstetric Patients: A decade of surgical intensive care experience

Despite the emergence of therapeutic advances, the morbidity and mortality still occur in the obstetric patients, although intensive care utilization by obstetric and gynecological patient, are still rare compared to the general population. Majority of obstetric patients needed the intensive care therapy compared to gynecological patients. The aim of our study was to know the indications for the intensive care admission by obstetric and gynecological patients, length of stay and outcome of these patients. Methods: We retrospectively reviewed the medical records of all obstetric and gynecological patients admitted to our Surgical and Trauma Intensive Care Units (SICU and TICU) from February 1995 to March 2005. Indication for admission, nationality, age, and length of stay in ICU, severity of disease and outcome of these patients were recorded. Data analyzed with SPSS program. Results: A total of 182 patients were admitted to the SICU of the Hamad Medical Corporation in Doha, Qatar, from the Women's Hospital. 159 (87%) patients were obstetric patients and 23 (13%) patients gynecological patients, 126 (69.6%) patients were admitted post Lower Segment Caesarean Section (LSCS). The most common indication for admission was 73 (39.3%) patients obstetric hemorrhage and Disseminated Intravascular Coagulation (DIC), and then 44 (25.3%) patients of hypertensive disorder of pregnancy. The major anesthesia related indication was scoline apnea, 21 (11.6%). Total three obstetric patients died, two due to severe sepsis and multi-organ failure and one due to cerebral sinus thrombosis, giving mortality rate of 1.66%. Conclusion: Intensive care therapy required by gynecological and obstetric patient is less than the general population. The commonest indication for admission was obstetric hemorrhage, DIC, and hypertensive disorders of pregnancy. The mortality was due to septic shock with multi-organ failure, and cerebral venous sinus thrombosis.

Assessment of the Usefulness of Antithrombin-III in the Management of Disseminated Intravascular Coagulation in Obstetrically Ill Patients

The aim of this study was to analyze the antithrombin-III (AT-III) activity in the serum in relation to other laboratory findings, including the serum albumin, total protein (TP), and uric acid (UA), and to assess the recovery of the AT-III activity in the serum after its administration in obstetrically ill patients. The medical records of 27 patients who were diagnosed to have disseminated intravascular coagulation (DIC) based on the obstetric DIC scores were reviewed and the relationships between the activity of AT-III in the serum and other laboratory findings were evaluated. The effect of administration of AT-III on the recovery of AT-III activity in the serum was also evaluated. All the patients survived without any sequelae. The mean obstetric DIC score was 11.1 ± 3.1 (range 8-19) and the mean blood loss during the first 24 hours was 3798 ± 3,435 mL (range 480-16 208 mL). There was a significant correlation between the serum AT-III activity before the treatment and the serum albumin (r = .67, P = .001) and TP (r = .59, P = .021), but not serum UA. Seven patients required over 3000 IU of AT-III concentrate to obtain an increase in the serum AT-III activity to over 70%. The UA level in this group was significantly higher than that in the remaining patients. The serum AT-III activity was correlated with the serum albumin level before the start of treatment. Therefore, measurement of the serum albumin level before and during treatment is helpful.

Fetal/Neonatal Outcome in Abruptio Placentae during Preterm Gestation

The purpose of this study was to evaluate the fetal/neonatal outcome and to determine the important factors in that outcome, including the use of ultrasonography and fetal heart rate monitoring, in abruptio placentae during preterm gestation. A case-control study was performed using a logistic regression model. Adverse outcome was defined as neonatal death before hospital discharge or a diagnosis of cerebral palsy in surviving neonates. Stillbirth (group 1) occurred in eight of 50 cases of abruptio placentae (16%). Adverse outcome was seen in 11 survivors (11 of 42; 26.2%). The obstetrical disseminated intravascular coagulation (DIC) score in group 1 (11.8 +/- 7.1) was higher than that in the adverse (5.7 +/- 1.3) and satisfactory (5.3 +/- 2.4) outcome groups. A low Apgar score (< 7) at 5 minutes (odds ratio, 19.8; 95% confidence interval, 2.0 to 197.8) was associated with increased risk of adverse outcome in the logistic regression model. Although the obstetrical DIC score was high and may reflect the severity of maternal complications in the stillbirth group, there were no typical ultrasonographic findings and fetal heart rate patterns in abruptio placentae during preterm gestation predicting adverse outcome among survivors.