Disseminated Intravascular Coagulation in Pregnancy: Insights in Pathophysiology, Diagnosis, and Management

Abstract

(Am J Obstet Gynecol. 2015;213(4):452–463)

In this review, the authors discuss the underlying processes that lead to disseminated intravascular coagulation, the importance of an early diagnosis for this condition, and the principles of treatment. Disseminated intravascular coagulation is a serious medical emergency that is the result of uncontrolled systemic activation of the hemostatic system. This process creates a widespread microvascular thrombosis that can reduce the blood supply to various organs and potentially cause organ failure and uncontrolled bleeding. It is typically characterized by diffuse bleeding from multiple organs, hemorrhagic necrosis, microthrombi in small blood vessels, and thrombi in medium and large blood vessels. The underlying mechanisms of action may be endothelial dysfunction that leads to platelet activation and trophoblast disruption that releases tissue factor into the circulatory system. Disseminated intravascular coagulation can be brought about by a number of obstetric complications, including acute peripartum hemorrhage, placental abruption, preeclampsia, elevated liver enzymes/low platelet count syndrome, retained stillbirth, septic abortion, intrauterine infection, amniotic fluid embolism, and acute fatty liver of pregnancy.