A Case Of Disseminated Intravascular Coagulation Syndrome following a Twenty Week Missed Abortion

Abstract

Disseminated Intravascular Coagulation Syndrome (DIC) is defined as the pathological disruption of the balanced process of hemostasis that is characterized by systemic activation of the blood coagulation cascade, which results in generation and deposition of fibrin. This leads to formation of microvascular thrombi in small blood vessels and activation of plasmin causing fibrinolysis. This process combined leads to multiple organ dysfunction due to depleted platelets and clotting factors that are needed for hemostasis, thus presenting as excessive bleeding. While DIC in pregnancy is rare, only accounting for approximately 1-5% of all DIC cases in the general population, it occurs in 0.3-3.5% of delivery hospitalizations. The process itself can stem from a multitude of sources during pregnancy including, but not limited to, placental abruption, postpartum hemorrhage, Preeclampsia, Eclampsia, HELLP syndrome, acute fatty liver, amniotic fluid embolism, and pregnancy-related sepsis. Each individual diagnosis has distinct features and treatment regimens to prevent progression to Disseminated Intravascular Coagulation Syndrome. DIC is a major contributor to maternal mortality with approximately 20-25% of maternal deaths being related to hemorrhage, amniotic fluid embolism, or hypertensive disorders, all of which can be related to coagulopathies. Distinguishing features of hemodynamically stable and unstable patients guide the management and determine how quickly the team must react when actively managing Disseminated Intravascular Coagulation Syndrome in the pregnant population. The objective of this case study is to review a unique patient presentation that is consistent with a benign diagnosis that quickly progressed to a potentially life-threatening condition. By reviewing this case study, I intend to discuss the initial disease presentation, diagnosis, and treatment options of DIC in pregnancy.