Multiorgan dysfunction in a gravid woman with placental abruption and disseminated intravascular coagulation

Abstract

The most frequent obstetrical cause of coagulation disorders as disseminated intravascular coagulation is placental abruption, which can be found in women without any apparent clinical disturbances or in the state of established preeclampsia. Hypertension occurs in 5-8% of all pregnancies and may be complicated by preeclampsia. Preeclampsia is a complex clinical syndrome with insufficiently clear pathophysiology based on the damage of the vascular endothelium. As a result of this, generalized endothelial disruption in preeclampsia, a multiorgan dysfunction, can develop, most frequently reflected in the clinical presentation with haematological and renal disturbances and with a disordered function of the liver and central nervous system. We are presenting a case of a gravid woman with poorly regulated hypertension that resulted from development of preeclampsia, later complicated by placental abruption and disseminated intravascular coagulation (DIC) with multi-organ dysfunction. The importance of rapid recognition of coagulation disorder and the attempt at surgical treatment aiming at removal of the triggering mechanisms of DIC was shown, suggesting all the symptomatic therapeutic measures would be ineffective. Although our patient was surgically treated in the phase of generalised disorder characterised by development of coma, acute respiratory distress syndrome and renal insufficiency when mortality was 70%, the recovery of functions of all involved organs was achieved, except for the renal function that required chronic haemodialysis treatment.

Autoantibody against AT1 receptor from preeclamptic patients induces vasoconstriction through angiotensin receptor activation

“…Nevertheless, vascular damage is a hallmark of preeclampsia, leading to decreased vasodilatation, vascular smooth muscle cell proliferation and increased interaction between leukocytes and the vessel wall [8].…”

Emergency Obstetric Care, Essentialities for Prevention of Maternal/Neonatal Mortality/Morbidity

“…Woman with septic shock with hyperpyrexia; tachycardia; tachypnoea; evidence of pus intraperitoneal or intra viscera; injury to bladder/bowel; require procedures for which skilled persons; material and infrastructure are essential. Hypertensive disorders; especially complicated by Hepatic; Renal; Cardiovascular Failure; Cerebral Hemorrhage; Unconsciousness; Coma; Disseminated Intravascular Coagulation are dangerous, knowledge to diagnose and manage is essential [8].…”

Thromboembolic complications during pregnancy and delivery

“…Hiperkoagua-bilnost je najizraženija u momentu rađаnjа posteljice, jer tada dolazi do oslobađanja tromboplastičnih supstancija koje stimulišu formiranje krvnog ugruška radi uspostavljanja homeostaze nakon porođaja. Koagulacioni i fibrinolitički status se u potpunosti normalizuju četiri nedelje nakon porođaja [13,14].…”