Disseminated intravascular coagulation in pregnancy: New insights

Abstract

DIC is a leading cause of maternal mortality. It is secondary to obstetrical complications such as placental abruption, amniotic fluid embolism, HELLP syndrome, retained stillbirth and acute fatty liver of pregnancy. Abnormal activation of the hemostatic system can be compensated (non-overt) or decompensated (overt) DIC. Specific scores that were adjusted to the physiological changes during pregnancy can diagnose overt and non-overt DIC. The pregnancy specific DIC score has 88% sensitivity, 96% specificity, a LR+ of 22, and a LR-of 0.125 for the diagnosis of DIC. Management of DIC during pregnancy requires prompt attention to the underlying condition leading to this complication, including the delivery of the patient, and correction of the hemostatic problem that can be guided by point of care testing adjusted for pregnancy. Novel therapeutic modalities like fibrinogen concentrate may facilitate the management of DIC in pregnancy in low resources areas.