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[Obstetrical disseminated intravascular coagulation: a case report and literature review]
Y F F Song1, X Y Gong1, B Zang1
1Department of Critical Care Medicine, Shengjing Hospital of China Medical University, Shenyang 110004, China.
Insights
This case report details managing obstetrical disseminated intravascular coagulation (DIC) following amniotic fluid embolism. Prompt treatment with blood products and antifibrinolytics successfully saved the patient.
Area of Science:
- Obstetrics and Gynecology
- Hematology
- Critical Care Medicine
Background:
- Obstetrical disseminated intravascular coagulation (DIC) is a life-threatening condition.
- Amniotic fluid embolism can precipitate DIC, leading to severe maternal morbidity and mortality.
- Effective management requires a multidisciplinary approach addressing both the underlying cause and coagulopathy.
Purpose of the Study:
- To present a case of a 36-year-old primigravida experiencing DIC post-amniotic fluid embolism.
- To discuss the critical treatment strategies employed for this obstetric emergency.
- To review literature on managing obstetrical DIC to improve patient outcomes.
Main Methods:
- Analysis of clinical data and treatment course of a patient with cardiac arrest and DIC after amniotic fluid embolism.
- Review of relevant medical literature on obstetrical DIC management.
- Implementation of aggressive circulatory and respiratory support, surgical interventions, and comprehensive blood product transfusion.
Main Results:
- A 36-year-old primigravida developed cardiac arrest and DIC following amniotic fluid embolism during delivery.
- Aggressive management including blood component therapy (erythrocytes, plasma, cryoprecipitate, fibrinogen) and antifibrinolytics was initiated.
- The patient's life was saved with no irreversible organ damage, highlighting the efficacy of timely and comprehensive treatment.
Conclusions:
- Successful management of obstetrical DIC necessitates prompt treatment of the primary obstetric cause.
- Correction of coagulation dysfunction through appropriate component transfusion and antifibrinolytic therapy is crucial.
- Early and aggressive intervention significantly improves prognosis in cases of severe obstetrical DIC.
Abstract:
Objective: To report a case of obstetrical disseminated intravascular coagulation and discuss the treatment strategy of such cases. Method: The clinical data and treatment process of the patient with cardiac arrest and disseminated intravascular coagulation after amniotic fluid embolism was analyzed, and the related literature was reviewed. Results: Female, 36 years old, primigravida, was admitted to the hospital for delivery because of "amenorrhea for more than 9 months, lower abdominal pain for 14 hours with a small amount of vaginal bleeding for 2 hours", amniotic fluid embolism occurred after delivery, then cardiac arrest and DIC happened, which led to a large amount of blood loss, through the treatment methods of active circulatory and respiratory support, surgical interventions for two times, transfusion of erythrocytes, plasma, and cold precipitation, fibrinogen and other blood product for substitution, and early antifibrinolytic, the patient's life was successfully saved without irreversible organ function damage. Conclusions: For patients with obstetrical disseminated intravascular coagulation, in addition to treating the primary disease, it is necessary to correct coagulation function by component transfuse and antifibrinolytic as appropriate to improve the prognosis.
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