DIC in pregnancy.pptx

DIC in pregnancy

1. DIC IN PREGNANCY

2. Dillema Major management challenge Further complicated when the patient is carrying a fetus at or beyond the limit of viability. To transfuse a pregnant patient with DIC who is bleeding heavily or performing an emergency cesarean delivery on a pregnant patient with catastrophic hemorrhage.

3. Accounts for approximately 1 to 5 percent of all cases of DIC P revalence ranges from 0.03 to 0.35 percent of all delivery hospitalizations in population-based studies . Patients with specific pregnancy complications, such as placental abruption or amniotic fluid embolism, can be at very high risk ( eg , prevalence >20 percent) 

4. PATHOPHYSIOLOGY Pregnancy is a hypercoagulable state . The shift in the balance between the hemostatic and fibrinolytic systems serves to prevent excessive bleeding during placental separation Marked increases in most coagulation factors Decreased endogenous anticoagulation Reduced fibrinolysis Increased platelet reactivity.

5. PATHOPHYSIOLOGY Clot formation – driver of clot formation - tissue factor (TF). In pregnancy, important sites of injury resulting in TF generation or exposure are the placental/decidual interface in the setting of placental separation and necrosing fetoplacental tissue in the setting of retained fetal demise Exposure to endothelial collagen activates the intrinsic pathway, which plays a lesser role in development of disseminated intravascular coagulation (DIC). Both pathways converge into the common pathway of clot formation.

6. CAUSES Placental abruption Preeclampsia with severe features/eclampsia/HELLP syndrome ( hemolysis , elevated liver enzymes, low platelets) Amniotic fluid embolism Acute fatty liver of pregnancy Septic abortion Non Obstetric causes

7.   PPH with dilutional coagulopathy primary thrombotic microangiopathy von Willebrand disease antiphospholipid syndrome pulmonary embolism heparin-induced thrombocytopenia transfusion reaction