DIC Disseminated Intravascular Coagulation in Pregnancy

DIC can be recognized by small bruises, bleeding gums, and minor injuries after injections which take long to stop bleeding. DIC should be detected and managed early to prevent maternal death. The commonly used management methods are the use of coagulants and replacement of blood and blood products. Causes DIC in pregnancy is caused by as placenta abruption, pre-eclampsia or HELLP syndrome, post-partum bleeding, amniotic fluid embolism, acute fatty liver of pregnancy, septic abortion, and fetal loss. Placenta Abruption is the separation of the placenta from the uterus that is caused by the rupturing of the maternal decidual artery. It is difficult to diagnose DIC during this period, but the condition is characterized by hypotension, cyanosis, altered mental state, dyspnea, and bleeding.

Fatty acid liver occurs during the third trimester of pregnancy and is fatal (Sahin, Eroglu, Tetik & Guzin, 2014). The condition leads to severe hepatic dysfunction and the deficiency of Anti-Thrombin III which cause DIC. Lastly, fetal loss or intrauterine fetal demise (IUD) is commonly associated with DIC. If the fetus remains longer in the body, the mother can develop a coagulation problem due to the discharge of thromboplastin-like materials from the dead body (Sahin, Eroglu, Tetik & Guzin, 2014). Due to the formation of random clots, the coagulation factors are depleted leading to a continuous bleeding phase (Sahin, Eroglu, Tetik & Guzin, 2014). The mother is usually at risk of dying from massive blood loss or failure of internal organs if the condition is not managed early.

Diagnosis Currently, there is no specific test for DIC. Hence the diagnosis of DIC depends on the interpretation of hemostatic parameter and supportive laboratory tests (Thachil & Toh, 2009). The tests should be conducted based on the current conditions to accurately diagnose DIC. A study of DIC cases indicated that in 57% of the occurrences, the fibrinogen levels were normal (Thachil & Toh, 2009). During pregnancy, serial tests should be conducted to diagnose DIC accurately, because of the changing dynamics. Methods such as thromboelastography (TEG) and rotational TEG (ROTEG) analyze the whole fibrinolysis process is considered during diagnosis (Sahin, Eroglu, Tetik & Guzin, 2014). They analyze the process by measuring the speed, quality of the cot, and the structural strength of coagulation. The test can be conducted at bedside thus enabling nurses to address the DIC problem early.

blre. 002 Medical Management of Disseminated Intravascular Coagulation in Pregnancy A primary approach is used to address the obstetrical causes to manage DIC. However, supportive treatments may be required for some cases. The management methods are as discussed. Replacement of Blood Products A blood therapy should be administered based on a series of laboratory results and the clinician’s experience. Anticoagulants Heparin is used to inhibit coagulation and fibrinolysis by inhibiting the activities of thrombin in DIC. Fractionated heparin is the most recommended dose that should be administered at 10µ/kg/hr as a continuous intravenous infusion (Sahin, Eroglu, Tetik & Guzin, 2014). Other medications such as tranexamine asit and β-aminocaproic acid are only effective in life-threatening cases. Management of Massive Hemorrhage Postpartum bleeding is the main cause of maternal deaths and should hence be managed effectively to ensure the replacement of clotting factors and maintain the patient’s normotensive and normothermic (Sahin, Eroglu, Tetik & Guzin, 2014).