Disseminated Intravascular Coagulation

Disseminated intravascular coagulation (DIC) is a systemic condition characterized by widespread activation of the clotting cascade and fibrinolytic system resulting in microthrombi, multiorgan dysfunction, and a consumptive coagulopathy. DIC is associated with severe maternal morbidity, resulting in massive transfusion of blood products, acute tubular necrosis, cerebrovascular ischemia, and intensive care unit admission. Pregnancy is a hypercoagulable state, with increases in the circulating levels of coagulation factors. DIC can be precipitated by maternal sepsis. Management of the septic patient requires a multifaceted approach focused on maternal resuscitation and infection source control. The diagnosis of DIC is clinical, based upon underlying etiology, blood loss, and the general condition of the patient. Viscoelastic assays or viscoelastometric tests are point-of-care tests that can serve as adjuncts in identifying and managing disorders of hemostasis. The basic principles of managing obstetrical DIC are: multidisciplinary approach, treatment of obstetric causes, blood and blood products, and supportive care.