Recombinant Factor VII (Activated) for Haemorrhagic Complications of Severe Sepsis Treated with Recombinant Protein C (Activated)

Michalska-Krzanowska, Grażyna; Czuprynska, M.

doi:10.1159/000093643

Cited by 5 publications

References 25 publications

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Disseminated Intravascular Coagulopathy

Hossain

Paidas

2010

Critical Care Obstetrics

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Disseminated intravascular coagulopathy (DIC) is usually a very acute, serious complication of pregnancy. Obstetric conditions associated with DIC include abruptio placentae, induced abortion, intrauterine fetal death, sepsis, amniotic fluid embolism, preeclampsia, eclampsia, hydatiform mole, placentae accreta, and massive hemorrhage (1). We present a case of life-threatening DIC caused by placental abruption in the second trimester. The fetus was alive, but persistent heavy vaginal bleeding with severe uterine contractions necessitated urgent termination of pregnancy. Because the normal decreases in plasma protein S and C activities make it difficult to diagnose protein S and C deficiency in pregnancy (2), definitive diagnosis of protein S deficiency was made 6 months postpartum. CASE REPORTA 36-year-old woman, gravida 5, para 3, ectopic pregnancy 1 was admitted to our hospital at 19 weeks' gestation with vaginal bleeding and intense low abdominal pain. Recently at home, she had a history of lack of consciousness with a loss of postural tone, with a spontaneous recovery.On admission, her neurologic examination was normal. The blood pressure was 100/50 mmHg, the pulse 106 and fetal heart movements were detected. Her body temperature was 38ºC. She had mild uterine bleeding and contractions.She underwent three cesarean sections, and unilateral salpingectomy 9 years previously for an ectopic pregnancy. She had already received antenatal care and amniocentesis was performed at 16 weeks of gestation because of advanced maternal age. At the 13th and 17th weeks of gestation, she was hospitalized and observed for abortus imminence and ultrasound revealed a low-lying placentae and a minimal collection between uterine cavity and placentae. At 19 weeks of gestation, ultrasonographic examination revealed that the fetus was alive, with the mea-289 Summary: Disseminated intravascular coagulopathy (DIC) is an uncommon but serious complication of pregnancy. Placental abruption is the most common associated condition among the causes of acute obstetrical DIC. We present a case of life-threatening DIC complicating placental abruption in the second trimester of pregnancy with protein S deficiency as a triggering factor, which necessitated urgent termination of pregnancy.

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