Gyneco. Dr. Ezdehar.L3-DIC.ppertyuiopptx

obstetric

1. Disseminated Intravascular Coagulopathy Dr. Izdihar Nsaif Ali

2. Disseminated Intravascular Coagulopathy(DIC) Definition : Is a hematological condition that’s associated with thromboheamorrhagic disorders. Normal coagulation pathway In order to understand the change in DIC it is essential to have a fund knowledge of the normal coagulation mechanism: The coagulant response is initiated with formation of tissue factor & subsequent binding to factor VII a . As a result factor X is activated and thus prothrombin is converted to thrombin (factor IIa ) Thrombin play a major role in procoagulation , and anticoagulantion

3. Pathophysiology The underlying pathophysiology of DIC is systemic activation of the coagulation cascade leading to extensive fibrin deposition and subsequent microvascular thrombosis. Furthermore patient exhibit a tendency for sever bleeding associated with consumption of platelets and coagulation factors .

4. Causes of DIC Non obstetrical causes Trauma. Sepsis. Organ damage. Malignancy. Vascular aneurysm. Acute liver failure. Toxic and immunological causes. ABO incompatibility. Obstetrical causes Placental abruption ; 37%. Postpartum bleeding ;29%. Placenta Previa and accrete . Sever preeclampsia and HELLP syndrome; 14%. Acute fatty liver of pregnancy ; 8%. Sepsis ; 6%. Amniotic fluid embolism ;6%. Intrauterine fetal loss.

5. Clinical features Bleeding ; is usually the most frequent clinical finding. It manifests itself usually as ecchymosis, petechial , mucosal oozing, prolonged bleeding at vein puncture sites, surgical incision sites and from various systems especially the gastrointestinal system. Altered mental status. Acute renal failure. Hypoxia. Hypovolemic shock Abdominal compartment syndrome

6. Diagnosis There is no single laboratory test to diagnose DIC. The diagnosis is established based on clinical suspicion and supportive laboratory tests, these tests reflect only the conditions at a moment in time so repeating it aids in establishing the diagnosis. Scoring used in DIC diagnosis The international society of Thrombosis Hemostasis (ISTH) develop a scoring system for the diagnosis of DIC, this system is only appropriate for patients with an underlying disorder that can be associated with DIC. The scoring is done based on; Thrombocyte count Fibrin split products or D-Dimer Prolongation of prothrombin time (PT) Fibrinogen levels A score of five and higher is considered as overt DIC.

7. Treatment The treatment of DIC decided by multidisciplinary team involve obstetrician, physician, hematologist and anesthetist. The main goal of the treatment is to correct the underlying obstetrical cause . Once the precipitating cause is addressed DIC usually resolves. Besides, supportive treatment should be implemented to correct the coagulation disorders .

8. Replacement of blood and blood products * Whole blood Contain 500 ml lead to Increase serum fibrinogen by 12.5 mg/dl Platelet count by 10000-15000cells.

9. * Platelet suspensions Administered to patients with platelet counts less than 50x10 9 and actively bleeding . In patients without bleeding, platelet transfusion is limited to patients with platelet count less than 30x10 9 . Platelet : 1 pint contain 50 ml increase platelet count by 5000-10000 cells

10. * Fresh frozen plasma(FFP) administration Is indicated if active bleeding occurs in the setting of prolonged prothrombin time (PT) and activated partial thromboplastin time(APTT) at a dose of 10-20 ml/kg. FFP *1 Pint contain 250 ml *1 L (4 Pints) increase serum fibrinogen by 5-10 mg/dl .

11. In congenital isolated fibrinogen deficiencies with level less than 1 g/l, cryoprecipitate or fibrinogen concentrates should be used. Cryoprecipitate 1 pint contain 40 ml 2 pints increase serum fibrinogen by 1 g