Disseminated intravascular coagulation in obstetrics, pregnancy, and gynecology: Criteria for diagnosis and management

Hoppensteadt, D.

doi:10.1017/cbo9780511526978.002

Cited by 12 publications

(16 citation statements)

References 161 publications

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“…Clinically, DIC may lead to a wide range of pictures from unnoticed intravascular thrombosis and microvascular damage to uncontrollable bleeding. DIC always evolves secondary to predisposing clinical condition (5) . The real incidence of obstetrical DIC is unknown since it represents a wide spectrum ranging from mild to severe.…”

Section: Review (Derleme)mentioning

confidence: 99%

Disseminated Intravascular Coagulation in Obstetrics: Ethiopathogenesis and up to date Management Strategies

Şahin¹,

Eroğlu²,

Tetik³

et al. 2014

J Turk Soc Obstet Gynecol

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Section: Review (Derleme)mentioning

confidence: 99%

Disseminated Intravascular Coagulation in Obstetrics: Ethiopathogenesis and up to date Management Strategies

Şahin¹,

Eroğlu²,

Tetik³

et al. 2014

J Turk Soc Obstet Gynecol

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“…Ist zum Zeitpunkt der FE die Entbindung noch nicht abgeschlossen, kommt es häufig zu fetalen Bradykardien, die in 21% der Fälle zum Tod des Kindes und bei 50% der überlebenden Kinder zu neurologischen Defiziten führen [11].Das vermehrte Auftreten von Uterusatonien mit schweren Blutungen in dieser Situation wurde beobachtet [5]. Diese Konstellation scheint in dem hier vorgestellten Fall vorgelegen zu haben.Als Frühsymp-tome werten wir die initial beobachtete Unruhe und Verwirrtheit,kombiniert mit einer Dyspnoe und nachweisbarem Abfall der Sauerstoffsättigung.…”

Section: Symptomatikunclassified

“…Während der Geburt, finden sich zusätzlich höhe-re Konzentrationen von Prostaglandinen E 1 , E 2 , F 1α und F 2α [21,26]. Komplementaktivierende Faktoren, Plättchen-aktivierender Faktor (PAF) und andere prokoagulatorische Substanzen sind außerdem beschrieben worden [5]. Die Reaktion des mütterlichen Organismus auf diesen "Cocktail" kann sehr unterschiedlich ausfallen.…”

Section: Pathophysiologieunclassified

“…Diese Stö-rungen reichen von einer milden Thrombozytopenie bis hin zum Vollbild der DIC. Es gibt Hinweise dafür, dass das Fruchtwasser prokoagulatorische Substanzen enthält, die sowohl früh ("tissue factor") als auch spät (direkte Aktivierung von Faktor X) in die Gerinnungskaskade eingreifen können [5,20,22,24].Auch in dem hier berichteten Fall entwickelten sich erhebliche Gerinnungsstörungen, die in Zusammenschau der Befunde als DIC interpretiert werden müssen (Thrombozytopenie, Verminderung von Fibrinogen und Antithrombin,Test auf Fibrinspaltprodukte positiv, D-Dimere massiv erhöht).…”

Section: Abb 2 Symptome Und Ablauf Der Fruchtwasserembolieunclassified

“…Alle empfohlenen therapeutischen Maßnahmen haben daher mehr oder weniger supportiven Charakter oder stellen einen individuellen Heilversuch dar (Tabelle 2).Auch das Vorgehen in dem hier geschilderten Fall konnte darüber nicht hinausgehen.Neben dem Versuch der kardiozikulatorischen Stabilisierung standen akut die Substitution des Blutverlusts und die Behandlung der DIC im Vordergrund der Bemühungen. Wir haben uns initial auf die Applikation von Frischplasma beschränkt,da die Substitution von Fibrinogen und anderen Gerinnungsfaktoren bei einer DIC ohne vorherige Gabe von Heparin und Antithrombin den Verbrauchsprozess in der Regel verstärkt[5] und daher kontraindiziert ist (dies gilt auch für die Substitution von Thrombozyten, die nur als ultima ratio bei persistierender Blutung und Thrombozytenzahlen unter 50000/µl transfundiert werden sollten[20]). Ob ein intraoperativer Beginn der kombinierten Behandlung mit Heparin und Antithrombin den Verlauf der DIC abgemildert hät-te, muss offen bleiben.…”

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"Anaphylactoid syndrome of pregnancy"

Kretzschmar¹,

Zahm

Remmler

et al. 2003

Der Anaesthesist

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A 35-years old gravida IV and para II underwent caesarean section because of fetal distress following induction of labour. During operation the patient developed disseminated intravascular coagulation (DIC), severe haemorrhage and shock necessitating massive blood transfusion,hysterectomy with pelvic packing, and high-dose catecholamines. Ultimately, recombinant factor VIIa was given to control bleeding. During the first 24 hours after operation, both clinical and laboratory findings showed that the severe DIC was on the course to recovery.However, the patient subsequently developed multiple organ dysfunction syndrome with respiratory and renal failure requiring mechanical ventilation and haemodialysis.All therapeutical efforts could not help that the patient passed away due to an inevitable multiple organ failure on the 12th day after the operation. Given the constellation of diagnostic and clinical findings, the most likely diagnosis was amniotic fluid embolism (AFE), a rare complication of pregnancy. The following differential diagnoses were less likely or excluded in this reported patient: pre-eclampsia/pregnancy-induced hypertension,HELLP syndrome,anaphylaxis,uterine rupture, transfusion reactions,pulmonary embolism. AFE occurs rarely, and because studies in animal models cannot reproduce accurately the pathophysiological and clinical alterations seen in humans, its pathogenesis remains unclear. It has been proposed that the clinical syndrome of AFE occurs when fetal antigens pass the maternal immunological barrier in susceptible mothers. The recognition of fetal antigens by maternal immune system subsequently triggers the release of endogenous mediators that are responsible for dramatic pathophysiological disturbances.Furthermore, the components of amniotic fluid initiate the DIC. These events are more consistent with septic shock and anaphylactic shock than with an embolic process and it was proposed that the term "amniotic fluid embolism" be changed to "anaphylactoid syndrome of pregnancy". At present, no therapy has been found to consistently improve outcomes in women with AFE.Patients who survive the initial insult are at high risk for multiple organ failure. The mortality of AFE remains high.

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Immune Thrombocytopenia in Pregnancy

Stavrou

McCrae

2009

Hematology/Oncology Clinics of North America

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SYNOPSISManagement of ITP in pregnancy can be a complex and challenging task, and may be complicated by fetal/neonatal thrombocytopenia. Though fetal intracranial hemorrhage is a rare complication of ITP in pregnancy, invasive studies designed to determine the fetal platelet count before delivery are associated with greater risk than that of fetal intracranial hemorrhage, and therefore are discouraged. Moreover, the risk of neonatal bleeding complications does not correlate with the mode of delivery, and thus cesarean section should be reserved for obstetric indications only.

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Disseminated intravascular coagulation in obstetrics, pregnancy, and gynecology: Criteria for diagnosis and management

Cited by 12 publications

References 161 publications

Disseminated Intravascular Coagulation in Obstetrics: Ethiopathogenesis and up to date Management Strategies

Disseminated Intravascular Coagulation in Obstetrics: Ethiopathogenesis and up to date Management Strategies

"Anaphylactoid syndrome of pregnancy"

Immune Thrombocytopenia in Pregnancy

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