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Diagnosis and management of acute obstetrical DIC
1Department of Obstetrics and Gynecology, Hamamatsu University School of Medicine, Japan. tkoba@hama-med.ac.jp
Insights
Obstetrical disseminated intravascular coagulation (DIC) management prioritizes prompt diagnosis using the obstetrical DIC score. Early treatment initiation, even before lab results, is crucial for better outcomes in this severe pregnancy complication.
Area of Science:
- Obstetrics and Gynecology
- Hematology
- Critical Care Medicine
Background:
- Obstetrical disseminated intravascular coagulation (DIC) is a life-threatening obstetric complication.
- Prompt diagnosis and early intervention are critical for managing DIC in pregnancy.
- Existing diagnostic criteria (obstetrical DIC score) aid in timely decision-making.
Purpose of the Study:
- To outline effective management strategies for obstetrical DIC.
- To emphasize the importance of early diagnosis and treatment initiation.
Main Methods:
- Utilizing the obstetrical DIC score (based on underlying disease, clinical symptoms, and lab findings) to guide treatment decisions.
- Implementing strategies for controlling the underlying cause of DIC.
- Evaluating therapeutic options including Antithrombin (AT) therapy, synthetic serine protease inhibitors, and Activated Protein C (APC).
Main Results:
- Controlling the underlying cause, such as via cesarean section, is paramount.
- Antithrombin (AT) monotherapy is preferred over heparin due to fewer hemorrhagic side effects.
- Activated Protein C (APC) demonstrated safety and efficacy in treating DIC, particularly with placental abruption.
Conclusions:
- Early initiation of DIC therapy, with a score of 8 or more, is justified even before laboratory confirmation.
- Antithrombin (AT) therapy and Activated Protein C (APC) are effective treatments for obstetrical DIC.
- Management focuses on rapid etiological factor elimination and appropriate anticoagulant/antithrombotic therapies.
Unlabelled:
Obstetrical disseminated intravascular coagulation (DIC) is usually a very acute, serious complication of pregnancy. The DIC diagnostic criteria in obstetrics (the obstetrical DIC score) help with making a prompt diagnosis and starting treatment early. These DIC diagnostic criteria, in which higher scores are given for clinical parameters than for laboratory parameters, have three components: (1) the underlying disease, (2) clinical symptoms, and (3) laboratory findings. It is justified that it is appropriate to initiate therapy for DIC when the obstetrical DIC score reaches 8 points or more before obtaining the results of coagulation tests.
Management:
(1) Control of the underlying disease: because prolongation of exposure to the triggering factors worsens DIC, it is important to eliminate the etiologic factors as rapidly as possible. Elimination of the cause of DIC can be easily performed in obstetrics, for example, by cesarean section. (2) Antithrombin (AT) therapy: AT monotherapy (1,500 to 3,000 units/day, 2 days) is preferably employed instead of heparin monotherapy or heparin-AT therapy because of the hemorrhagic side effects of heparin. (3) Synthetic serine protease inhibitors: continuous infusion ofgabexate mesilate (FOY) or nafamostat mesilate (FUT) is effective for DIC. Controlled multicenter trials showed a significant improvement not only in clinical response but also in platelet counts and prothrombin time (PT) in the AT group compared with the FOY group. (4) Activated protein C (APC) can inhibit thrombin generation and accelerate fibrinolytic activity. APC (5,000 to 10,000 units) is administered for 2 days in patients with placental abruption complicated by DIC. APC is a very safe, effective, and useful agent for the treatment of DIC.