Intrapartum anti-disseminated intravascular coagulation therapy leading to successful vaginal delivery following intrauterine fetal death caused by placental abruption: a case report

Abstract

IntroductionDisseminated intravascular coagulation due to placental abruption with intrauterine fetal death is not uncommon. It can result in increased maternal mortality rates and the need for hysterectomy or greater transfusion volumes if the delivery is not completed within six to eight hours. However, consensus is lacking regarding the delivery approach for cases in which delivery is prolonged.Case presentationA 37-year-old Japanese woman was transported to our tertiary center two and a half hours after the onset of labor because of a diagnosis of placental abruption with intrauterine fetal death at 40 weeks and three days’ gestation. On arrival, although severe hypofibrinogenemia was observed, there was no external hemorrhage. Because her cervical canal dilation was good (Bishop score, 7), labor was induced using oxytocin. Anti-disseminated intravascular coagulation therapy was simultaneously started via transfusion. After her hypofibrinogenemia resolved, delivery progressed rapidly, and the fetus was delivered approximately 10 hours after the onset. To reduce postpartum hemorrhage, 6g of fibrinogen concentrate and tranexamic acid, an antifibrinolytic agent, were administered immediately before extraction of the dead fetus and placenta. Although the amount of intrapartum hemorrhage was 1824g, there was no abnormal bleeding after delivery, and our patient was discharged three days later.ConclusionIn cases of placental abruption complicated with disseminated intravascular coagulation, intrapartum administration of coagulation factors can simultaneously promote effective labor and correct hypofibrinogenemia, enabling minimally invasive vaginal delivery.

Pre‐delivery fibrinogen predicts adverse maternal or neonatal outcomes in patients with placental abruption

“…In the present study, the high PPV of the fibrinogen level to predict massive hemorrhage highlights the urgency for transfusion preparations. Preparation of a sufficient amount of blood products or administration of fibrinogen concentrate might help reduce the risk of hysterectomy or worsening DIC in cases with extremely low fibrinogen levels . A rapid assay to measure fibrinogen levels has been developed recently, and it may be considered as an alternative for plasma fibrinogen measurement .…”

Produção científica acerca do descolamento prematuro da placenta

“…Pela seleção das publicações, constituíram o corpus de análise, o total de sete [6][7][8][9][10][11][12] artigos, sendo um do LILACS 6 e seis da PUBMED. [7][8][9][10][11][12] Os artigos foram publicados em periódicos variados, um 6 nacional e seis [7][8][9][10][11][12] internacionais, todos de autoria médica.…”

“…[7][8][9][10][11][12] Os artigos foram publicados em periódicos variados, um 6 nacional e seis [7][8][9][10][11][12] internacionais, todos de autoria médica. Em relação ao ano de publicação, a maioria dos artigos é dos anos de 2014 [7][8] No que concerne à via de parto, a literatura não possui um consenso, mas a cesariana é o procedimento mais realizado nesses casos, por se tratar de uma emergência obstétrica de alto risco materno-fetal. Em relato de caso sobre gestante japonesa, com 40 semanas de gestação, colo uterino favorável, sinais vitais maternos estáveis e ausência de batimentos cardiofetais, optou-se pelo parto vaginal induzido com ocitocina, para evitar uma intervenção mais invasiva.…”

“…Em relato de caso sobre gestante japonesa, com 40 semanas de gestação, colo uterino favorável, sinais vitais maternos estáveis e ausência de batimentos cardiofetais, optou-se pelo parto vaginal induzido com ocitocina, para evitar uma intervenção mais invasiva. 7 [14][15] Dentre os fatores de risco para DPP, estudo de coorte realizado na Tanzânia apontou hipertensão crônica, pré-eclâmpsia/eclampsia, cesariana em parto anterior, DPP em parto anterior, poucas consultas de pré-natal e multiparidade. Como complicações maternas, ocorreram maiores taxas de hemorragia pré e pós-parto, cesariana, necessidade de transfusão sanguínea, função alterada do fígado e mortalidade materna.…”

The Importance of Supportive Care with Tranexamic Acid in Crimean-Congo Hemorrhagic Fever

“…The Clinical Randomisation of Antifibrinolytics in Hemorrhage (CRASH-2) study reported that it very significantly reduced hemorrhage and associated mortality in 20,000 trauma patients with major hemorrhage but caused no increase in vascular occlusive events compared to a control group [9]. Tranexamic acid is today effectively used in several hemorrhagic conditions, such as menorrhagia, postnatal bleeding, postcardiac surgery bleeding, intracranial bleeding and hemorrhage associated with disseminated intravascular coagulation [10,11,12,13]. The vascular system plays a key role in CCHF, and particularly in the development of endothelial disease [2].…”