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Risk Factors Associated with Development of Disseminated Intravascular Coagulation (DIC) in Obstetrical Cases
S Munira1, S Hossain, H Siddiqui
1Dr Sirajum Munira, Medical Officer, Dhaka Medical College and Hospital, Dhaka, Bangladesh;
Insights
Disseminated intravascular coagulation (DIC) in pregnancy is a major cause of maternal mortality. Key risk factors include abruptio placenta, postpartum hemorrhage, and preeclampsia, highlighting the need for rapid identification and management.
Area of Science:
- Obstetrics and Gynecology
- Hematology
- Critical Care Medicine
Background:
- Disseminated intravascular coagulation (DIC) is a life-threatening condition with high maternal mortality rates globally.
- In pregnancy, DIC is a critical obstetric emergency, often stemming from coagulation cascade overactivation leading to microvascular thrombosis and organ dysfunction.
- Also known as consumption coagulopathy, DIC presents as severe bleeding disorders.
Purpose of the Study:
- To investigate the specific obstetrical risk factors contributing to the development of DIC in pregnant women.
- To identify common clinical presentations and outcomes associated with DIC in an obstetric population.
Main Methods:
- A descriptive, cross-sectional study involving 300 pregnant women diagnosed with DIC at Dhaka Medical College Hospital from January 2020 to December 2022.
- Data collection included detailed patient history, clinical examinations, and relevant investigations to identify obstetrical risk factors.
- Statistical analysis was performed using SPSS version 22.0.
Main Results:
- Abruptio placenta (34.0%), postpartum hemorrhage (PPH) (27.0%), and preeclampsia/eclampsia (22.0%) were significant risk factors for DIC.
- Hypertension (72.0%), antepartum hemorrhage (45.3%), and PPH (38.7%) were frequently observed comorbidities.
- Maternal mortality was 12.0% and perinatal mortality was 24.3%.
Conclusions:
- Obstetrical complications such as abruptio placenta, PPH, and hypertensive disorders are major drivers of DIC in pregnancy.
- High rates of maternal and perinatal mortality underscore the severity of DIC in obstetric cases.
- Prompt recognition and effective management strategies are crucial for improving outcomes in pregnant women with DIC.
Abstract:
Disseminated intravascular coagulation (DIC) is a fatal clinical syndrome which is caused by many medical, surgical, and obstetric issues. In pregnancy, DIC constitutes one of the leading causes for maternal mortality globally. It is triggered by enhanced activities of the coagulation cascade which consequently predisposes to widespread microvascular thrombosis, impairment of supply of blood to multiple organs systems. It is known as consumption coagulopathy thus manifested as bleeding disorders. Objective of the study was to evaluate the risk factors which are contributed with the genesis of DIC in different obstetrical cases. This descriptive type of cross-sectional study was carried out in the Department of Obstetrics and Gynecology of Dhaka Medical College Hospital, Dhaka, Bangladesh during January 2020 to December 2022. A total of 300 pregnant women with DIC and admitted for termination of pregnancy constituted the study population. Detail history and relevant clinical examination were performed. Obstetrical factors that cause DIC were determined from clinical examination along with relevant investigations. Statistical analysis of the results was obtained by using windows computer software with Statistical Packages for Social Sciences (SPSS-version 22.0). More than a half (58.0%) of the women never received proper antenatal checkup. Regarding the risk factors for development of DIC; abruptio placenta was associated with 102(34.0%) patients followed by 81(27.0%) Postpartum hemorrhage (PPH) and 66(22.0%) preeclampsia and eclampsia. Among the risk factors of DIC, 216 (72.0%) showed hypertension, 136(45.3%) associated with antepartum heamorrhage and 116(38.7%) suffered PPH. More than two third (68.0%) of women had spontaneous vaginal delivery. Almost two third (63.7%) women's hospital stays were 8-14 days. Maternal and perinatal deaths were found in 36(12.0%) and in 73(24.3%) cases respectively. Maternal and perinatal mortality in women with DIC continues to be still high across the globe. Therefore attention should be focused in the rapid identification of the vulnerable cases along with proper management.
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