Disseminated intravascular coagulation (
DIC) is a syndrome that can be initiated by a myriad of medical, surgical, and obstetric disorders. Also known as consumptive coagulopathy,
DIC is a common contributor to maternal morbidity and mortality and is associated with up to 25% of
maternal deaths. The etiopathogenesis of
DIC is complex and currently thought to be initiated by
tissue factor or
thromboplastin, which is released from trophoblastic or fetal tissue, or maternal decidua or endothelium.
Tissue factor activates the coagulation sequence to cause
fibrin clotting and its dissolution by the
fibrinolysin system. The result of this process can range from mild, clinically insignificant laboratory derangements to marked coagulopathy with
bleeding at sites of minimal
trauma. Although clinical recognition varies by disease severity, several organizations have attempted to standardize the diagnosis through development of scoring systems. Several important--albeit not necessarily common--obstetric disorders associated with
DIC include
placental abruption,
amniotic fluid embolism,
sepsis syndrome, and
acute fatty liver of pregnancy. More common disorders include severe
preeclampsia,
hemolysis, elevated liver
enzymes, and low platelet count syndrome, and massive obstetric
hemorrhage. Importantly, many of these disorders either cause or are associated with substantive obstetric
hemorrhage. Treatment of
DIC is centered on two principles. The first is identification and treatment of the underlying disorder. Because many women with consumptive coagulopathy also have massive
hemorrhage, the second tenet of treatment is that obstetric complications such as
uterine atony or
lacerations must be controlled simultaneously with prompt blood and component replacement for a salutary outcome.