Concealed abruptio-placenta and disseminated intravascular coagulopathy: a near fatal management experience in a peripheral center

Abstract

Disseminated Intravascular Coagulopathy (DIC) is a fatal complication. In pregnant mothers concealed abruptio placenta though less commonly occurring but more dangerous is a compounding factor for development of DIC. Ascending uterine infection in premature rupture of membranes and PIH are also compounding factors in causing DIC. However, the outcome is not very positive in majority of the cases. While managing such cases in peripheral setting, it is most pertinent to keep in mind the possibility of rapid deterioration of clinical condition of such patients, which might progress to fatality. Therefore, timely institution of resuscitative and supportive measures in such labile patient is of utmost necessity while delivering peri and post-operative care. The interesting case report discussed in this patient also was of life threatening severity but timely institution of whole blood transfusion, FFP and fluid support was immensely helpful in saving the patient in peripheral setup despite her undergoing three consecutive life saving surgeries and a peri-operative cardiac arrest.

Placenta accreta spectrum conservative management and coagulopathy: case series and systematic review

“…by a collection of blood) 26 . Additionally, the degree of placental separation seen in abruption has been linked to the severity of the coagulopathy 22,24 , with CPA constituting a more severe risk for DIC 27,28 . This excessive release of TF in response to a disrupted uteroplacental interface is also applicable to PAS.…”

Anaesthetic management of disseminated intravascular coagulation associated with abruptio placentae and intrauterine death

“…Abruptio placenta can lead to rapid separation of the placenta and result in foetal demise. [ 1 2 ] Secondary to abruption, disseminated intravascular coagulation (DIC) can occur due to inappropriate activation of the coagulation and fibrinolytic system. [ 3 4 ]…”