[Disorders of hemostasis in intrauterine fetal death. Pathogenetic and therapeutic considerations]

When a dead fetus has remained in utero, an abnormality in haemostasis can be observed depending on the duration of retention. The most significant symptom is hypofibrinogenemia. Publications on the subject show in addition to a variety of symptoms a non-uniform pathogenetic pathway of the haemostatic disorder: Both an isolated hyperfibrinolysis and disseminated intravascular coagulation (DIC) with subsequent secondary activation of fibrinolysis have to be taken into consideration of the pathomechanism of the haemostasis defect. The triggering of DIC is possibly connected to the presence of the dead fetus and placenta, a primary hyperfibrinolysis seems to be induced by the mechanical factor of labors or curettage. The management of the haemostatic failure should be directed at the pathogenetic considerations; the appropriate treatment may be life-saving, when the haemostatic conditions become precarious inducing a bleeding tendency.