Disseminated Intravascular Coagulation (DIC) During Pregnancy

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Disseminated intravascular coagulation (DIC) is rare condition in women of reproductive age, yet it is reported to strike up to 35 of every 1,000 pregnancies. This is a condition that starts with excessive clotting of blood. As the clotting continues, this uses up supplies of platelets (cell fragments needed for blood clotting) and clotting proteins. Along with red blood cells and white blood cells, platelets are part of the cellular portion of blood. This contrasts with the liquid portion of blood, which is plasma and all of the various enzymes and other chemicals within it. Platelets work together with various proteins that are released from the walls of blood vessels, but overall the job of platelets is to form blood clots and, when the numbers of platelets in blood drop below a certain number per blood volume, the person is said to have thrombocytopenia, a low platelet count. This, in turn, results in the opposite of clotting, namely too much bleeding. During pregnancy, DIC can be triggered by other pregnancy complications, such as preeclampsia/eclampsia, elevated liver enzymes and low platelet (HELLP) syndrome, placental abruption, placenta previa, septic abortion, intrauterine infection, acute fatty liver of pregnancy, peripartum hemorrhage, intrauterine fetal demise, and amniotic fluid embolism. DIC also can be triggered by infection or other situations in which there is inflammation, by an uncontrolled drop in core body temperature (accidental hypothermia), burns, pancreatitis, snake venom, trauma, surgery, and cancer.

Diagnosis of DIC involves mostly the laboratory. There will be signs and symptoms, such bruising, bleeding, petechiae (dots on the skin), and low blood pressure, but your doctor will make the diagnosis base on test results. The doctor will order various tests, such as a complete blood count (CBC), a blood smear, fibrin degradation product, platelet count, prothrombin time (PT), activated partial thromboplastin time (aPTT), the D-dimer test, and serum fibrinogen. When DIC develops in any situation, it means that the blood clotting system is out of control. When it develops during pregnancy, it also generally means that whichever complications have been occurring have taken a turn for the worse. The lives of both the mother and the fetus are in serious danger at such a point.

In some cases, such as in settings of intrauterine demise (IUD, death of the fetus within the womb), treatment of DIC resulting from the condition can include heparin, an anticoagulation agent that comes in different forms. The main forms of heparin used in pregnancy, including for DIC are low molecular weight heparin (LMWH) and unfractionated heparin (UFH). Of these, LMWH usually is preferred over UFH. Any possible danger to the fetus from these medications is minor compared with the danger of DIC. The rational for heparin therapy is that it can offset the clotting process that occurs at a certain location, such as in the placenta, and that is consuming the clotting factors. Additionally, if the underlying cause of the DIC is infection, antibiotic therapy is an important component of treatment. The danger of DIC is always greater than the danger of any antibiotics. However, there are antibiotic regimens that are both effective and considered to be pregnancy safe. Treatment also includes transfusion of blood products. If you are suffering from DIC, then you are unlikely to be in a situation in which you can nurse, so issues of medications and breastfeeding rarely come up

The main treatment for DIC in pregnancy is not medications but treatment or removal of the source of the DIC, which often means the placenta, and also surgical repair of any sources of bleeding. This in turn can mean that an attempt is made to deliver the baby even if it is fairly early, or in some cases in can mean a hysterectomy (removal of the uterus). Treatment also includes transfusion of blood products, such as red blood cells (called packed red blood cells [PRBCs]), along with other blood products, such as fresh frozen plasma (FFP) and certain clotting factors, or inhibitors of certain factors in the blood. Platelets are infused if the woman’s platelet count is below a certain level and that level depends on her bleeding status.

David Warmflash
Dr. David Warmflash is a science communicator and physician with a research background in astrobiology and space medicine. He has completed research fellowships at NASA Johnson Space Center, the University of Pennsylvania, and Brandeis University. Since 2002, he has been collaborating with The Planetary Society on experiments helping us to understand the effects of deep space radiation on life forms, and since 2011 has worked nearly full time in medical writing and science journalism. His focus area includes the emergence of new biotechnologies and their impact on biomedicine, public health, and society.

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