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Published on: July 19, 2018
Disseminated intravascular coagulopathy and subsequent kidney injury requiring dialysis after a second-trimester
Shilpa Melanie Darivemula1, Clay Block2, Gauri Luthra3
1Department of Obstetrics and Gynecology, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA shilpa_darivemula@med.unc.edu.
A primigravida in her 20s with a body mass index of 18 underwent dilation and evacuation at 22 and 4 weeks gestational age to manage an intrauterine fetal demise (IUFD) that had occurred 14 days ago. Hypoxaemia and vaginal bleeding developed 90 min postprocedure. Investigations demonstrated changes compatible with acute respiratory distress syndrome secondary to disseminated intravascular coagulopathy which was managed with intubation, mechanical ventilation and transfusion of blood products. Although the coagulopathy and respiratory failure resolved, severe acute kidney injury ensued resulting in acute tubular necrosis, severe labial oedema and the need for prolonged support with haemodialysis until kidney recovery 7 weeks later.
A primigravida in her 20s with a body mass index of 18 underwent dilation and evacuation at 22 and 4 weeks gestational age to manage an intrauterine fetal demise (IUFD) that had occurred 14 days ago. Hypoxaemia and vaginal bleeding developed 90 min postprocedure. Investigations demonstrated changes compatible with acute respiratory distress syndrome secondary to disseminated intravascular coagulopathy which was managed with intubation, mechanical ventilation and transfusion of blood products. Although the coagulopathy and respiratory failure resolved, severe acute kidney injury ensued resulting in acute tubular necrosis, severe labial oedema and the need for prolonged support with haemodialysis until kidney recovery 7 weeks later.
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