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Analysis of Modified ISTH DIC Score in Cases of Abruptio Placentae and Its Correlation with Severity of Abruptio
Tehin Chou1, Archana Thakur2, Kavita N Singh2
1Department of Obstetrics and Gynaecology, Netaji Subhash Chandra Bose Medical College And Hospital, Jabalpur, (M.P.) Pin Code 482003 India.
Insights
The modified International Society of Thrombosis and Haemostasis (ISTH) DIC score effectively predicts disseminated intravascular coagulation (DIC) in abruptio placentae cases. Early prediction using this score, especially in severe abruption, aids timely management and reduces maternal complications.
Area of Science:
- Obstetrics and Gynecology
- Hematology
- Critical Care Medicine
Background:
- Disseminated intravascular coagulation (DIC) is a life-threatening condition often secondary to underlying disorders, with abruptio placentae being a common obstetric cause.
- Effective prediction of DIC in abruptio placentae is critical for timely intervention and improved maternal outcomes.
- The modified International Society of Thrombosis and Haemostasis (ISTH) DIC score offers a potential tool for early DIC detection in this obstetric emergency.
Purpose of the Study:
- To analyze the utility of the modified ISTH DIC score for predicting DIC in patients with abruptio placentae.
- To correlate the modified ISTH DIC score with the severity of placental abruption.
- To optimize the use of the modified ISTH DIC score in resource-limited settings for managing abruptio placentae.
Main Methods:
- A prospective observational study involving 126 participants with abruptio placentae (gestation > 28 weeks).
- Calculation of the modified ISTH DIC score for each participant, with a score > 26 indicating a high probability of DIC.
- Correlation of the calculated DIC scores with the degree of abruption based on the Page classification of severity.
Main Results:
- 47 participants (37.3%) presented with a high probability of DIC, all requiring blood product transfusion.
- Among those with high DIC probability, 80.85% had Grade 3 and 19.15% had Grade 2 abruption.
- A statistically significant association (p < 0.001) was observed between the grade of abruption and the modified ISTH DIC score.
Conclusions:
- The modified ISTH DIC score is a valuable tool for the early prediction of DIC in cases of abruptio placentae.
- Utilizing this score, particularly in Grade 2 and Grade 3 abruption, can facilitate prompt management.
- Early DIC prediction and management are crucial for reducing maternal morbidity and mortality associated with abruptio placentae.
Background:
Disseminated intravascular coagulation (DIC) is a potentially fatal condition which is always secondary to an underlying disorder with abruption being the most common cause in obstetrics.Our study analysed the modified International Society of Thrombosis and Haemostasis DIC score for prediction of DIC in cases of abruptio placentae. Additionally, we correlated the score with severity of abruption to optimize its use in limited resource settings.
Methods:
This was a prospective observational study of 126 participants admitted in Netaji Subhash Chandra Bose Medical College and Hospital, with the diagnosis of Abruptio Placentae and period of gestation more than 28 weeks. Modified ISTH DIC score calculated. A value > 26 suggested high probability of DIC. Resultant score of each participant was correlated with degree of abruption adapted from Page classification of severity of placental abruption.
Results:
In present study, 47 participants (37.3%) with abruptio placentae had high probability of DIC and all of them needed blood/blood product transfusion. Out of these 47 participants, 38 participants (80.85%) had Grade 3 abruption;while 9 participants(19.15%) had Grade 2 abruption. Association between grade of abruption and modified ISTH DIC score was found to be statistically significant (p value 0.001).
Conclusion:
Anticipation and early prediction of disseminated intravascular coagulation is crucial for timely management of participants at risk. Present prospective study concludes that Modified ISTH DIC Score should be used for early prediction of DIC in cases of abruptio placentae; especially in cases with Grade 2 and Grade 3 abruption; to reduce overall maternal morbidity and mortality.
