Is blood transfusion necessary in all patients with disseminated intravascular coagulation associated postpartum hemorrhage?

Çelik, Hale Göksever; Engin, Çağatay; Özdemir, İsmail; Savkli, Ayse Ozge; Şanlı, Kamuran; Görgen, Hüsnü

doi:10.1080/14767058.2017.1397125

Cited by 6 publications

(3 citation statements)

References 16 publications

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“…The pregnancy‐modified ISTH score was calculated based on a population of 24 646 pregnancies without and 87 with DIC (n = 24 693), had a 96% specificity, 36 and in an independent study attained a sensitivity of 78% and a specificity of 97% 45 . This modified score has proven useful for the identification of patients at risk for obstetrical hemorrhage requiring blood product transfusion 36,46,47 and can be applied in COVID‐19–affected pregnancies.…”

Section: Covid‐19 Coagulopathies In Pregnancymentioning

confidence: 99%

COVID‐19 coagulopathy in pregnancy: Critical review, preliminary recommendations, and ISTH registry—Communication from the ISTH SSC for Women’s Health

Kadir

Kobayashi

Iba

et al. 2020

Journal of Thrombosis and Haemostasis

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Background: Novel coronavirus (SARS-CoV-2), which causes COVID-19, has thus far affected more than 15 million individuals, resulting in more than 600 000 deaths worldwide, and the number continues to rise. In a large systematic review and metaanalysis of the literature including 2567 pregnant women, 7% required intensive care admission, with a maternal mortality ~1% and perinatal mortality below 1%. There has been a rapid increase in publications on COVID-19-associated coagulopathy, including disseminated intravascular coagulopathy and venous thromboembolism, in the non-pregnant population, but very few reports of COVID-19 coagulopathy during pregnancy; leaving us with no guidance for care of this specific population. Methods: This is a collaborative effort conducted by a group of experts that was reviewed, critiqued, and approved by the International Society on Thrombosis and Haemostasis Subcommittee for Women's Health Issues in Thrombosis and Hemostasis. A structured literature search was conducted, and the quality of current and emerging evidence was evaluated. Based on the published studies in the non-pregnant and pregnant population with a moderate to high risk of bias as assessed by Newcastle-Ottawa scale and acknowledging the absence of data from randomized clinical trials for management of pregnant women infected with SARS-CoV-2, a consensus in support of a guidance document for COVID-19 coagulopathy in pregnancy was identified. Results and Conclusions: Specific hemostatic issues during pregnancy were highlighted, and preliminary recommendations to assist in the care of COVID-19-affected pregnant women with coagulopathy or thrombotic complications were developed. An international registry to gather data to support the management of COVID-19 and associated coagulopathy in pregnancy was established. K E Y W O R D S COVID-19 , COVID-19 pregnancy registry, pregnancy and coagulopathy, pregnancy and venous thromboembolism, thromboprophylaxis in pregnancy | 3087 KADIR et Al.

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Section: Covid‐19 Coagulopathies In Pregnancymentioning

confidence: 99%

COVID‐19 coagulopathy in pregnancy: Critical review, preliminary recommendations, and ISTH registry—Communication from the ISTH SSC for Women’s Health

Kadir

Kobayashi

Iba

et al. 2020

Journal of Thrombosis and Haemostasis

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“…The activities of coagulation factors I, II, V, VII and X in plasma can be reflected by PT and TT. We found that PT and TT were significantly prolonged in the PPH after CD group, indicating impaired coagulation in the study group compared to the control group, which may be associated with massive hemorrhage 53 .…”

Section: Discussionmentioning

confidence: 66%

Risk-factor model for postpartum hemorrhage after cesarean delivery: a retrospective study based on 3498 patients

Gong

Chen

Zhang

et al. 2022

Sci Rep

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This study aimed to investigate the risk factors of patients with postpartum hemorrhage (PPH) after cesarean delivery (CD) and to develop a risk-factor model for PPH after CD. Patients were selected from seven affiliated medical institutions of Chongqing Medical University from January 1st, 2015, to January 1st, 2020. Continuous and categorical variables were obtained from the hospital’s electronic medical record systems. Independent risk factors were identified by univariate analysis, least absolute shrinkage and selection operator and logistic regression. Furthermore, logistic, extreme gradient boosting, random forest, classification and regression trees, as well as an artificial neural network, were used to build the risk-factor model. A total of 701 PPH cases after CD and 2797 cases of CD without PPH met the inclusion criteria. Univariate analysis screened 28 differential indices. Multi-variable analysis screened 10 risk factors, including placenta previa, gestational age, prothrombin time, thrombin time, fibrinogen, anemia before delivery, placenta accreta, uterine atony, placental abruption and pregnancy with uterine fibroids. Areas under the curve by random forest for the training and test sets were 0.957 and 0.893, respectively. The F1 scores in the random forest training and test sets were 0.708. In conclusion, the risk factors for PPH after CD were identified, and a relatively stable risk-factor model was built.

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“… 135 Moreover, a retrospective analysis of blood product transfusion requirements in patients with PPH revealed that according to the pregnancy specific DIC score, blood transfusion was unnecessary in 179 of the 279 postpartum women (64.1%) suggesting that its use may prevent unnecessary transfusions and their related risks and complications. 136 Recently, Clark et al, 137 suggested an additional modified version of the ISTH DIC score. Erez et al 138 tested the performance of this suggested scoring system on their cohort and found that this score had 14.9% sensitivity, 99.9% specificity, and a LR+ score of 14.9.…”

Section: Diagnosis Of Dic In Pregnancy: Clinical Definitions Laboratory Findings and Scoring Systemsmentioning

confidence: 99%

DIC in Pregnancy – Pathophysiology, Clinical Characteristics, Diagnostic Scores, and Treatments

Erez¹,

Othman²,

Rabinovich³

et al. 2022

JBM

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Obstetrical hemorrhage and especially DIC (disseminated intravascular coagulation) is a leading cause for maternal mortality across the globe, often secondary to underlying maternal and/or fetal complications including placental abruption, amniotic fluid embolism, HELLP syndrome (hemolysis, elevated liver enzymes and low platelets), retained stillbirth and acute fatty liver of pregnancy. Various obstetrical disorders can present with DIC as a complication; thus, increased awareness is key to diagnosing the condition. DIC patients can present to clinicians who may not be experienced in a variety of aspects of thrombosis and hemostasis. Hence, DIC diagnosis is often only entertained when the patient already developed uncontrollable bleeding or multi-organ failure, all of which represent unsalvageable scenarios. Beyond the clinical presentations, the main issue with DIC diagnosis is in relation to coagulation test abnormalities. It is widely believed that in DIC, patients will have prolonged prothrombin time (PT) and partial thromboplastin time (PTT), thrombocytopenia, low fibrinogen, and raised D-dimers. Diagnosis of DIC can be elusive during pregnancy and requires vigilance and knowledge of the physiologic changes during pregnancy. It can be facilitated by using a pregnancy specific DIC score including three components: 1) fibrinogen concentrations; 2) the PT difference -relating to the difference in PT result between the patient's plasma and the laboratory control; and 3) platelet count. At a cutoff of ≥26 points, the pregnancy specific DIC score has 88% sensitivity, 96% specificity, a positive likelihood ratio (LR) of 22, and a negative LR of 0.125. Management of DIC during pregnancy requires a prompt attention to the underlying condition leading to this complication, including the delivery of the patient, and correction of the hemostatic problem that can be guided by point of care testing adjusted for pregnancy.

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Is blood transfusion necessary in all patients with disseminated intravascular coagulation associated postpartum hemorrhage?

Cited by 6 publications

References 16 publications

COVID‐19 coagulopathy in pregnancy: Critical review, preliminary recommendations, and ISTH registry—Communication from the ISTH SSC for Women’s Health

COVID‐19 coagulopathy in pregnancy: Critical review, preliminary recommendations, and ISTH registry—Communication from the ISTH SSC for Women’s Health

Risk-factor model for postpartum hemorrhage after cesarean delivery: a retrospective study based on 3498 patients

DIC in Pregnancy – Pathophysiology, Clinical Characteristics, Diagnostic Scores, and Treatments

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