Severe disseminated intravascular coagulation produced at home in the third trimester of pregnancy - two case reports
A.A. Simionescu, S. Stoica, A. Hetea
Rezumat: Disseminated intravascular coagulation (DIC)
associated to pregnancy represents a rare event,
with a potential fatal evolution: studies show a
0.03% to 0.35% incidence during pregnancy. It may
be suspected during labor when is associated with
either major bleeding, or thromboses. Here, we report
two peculiar cases occurred before premature labor.
Our purpose is to adapt the available laboratory
tests into the clinical situation in order to obtain
the best management. The first case, a 32-year-old
para 6 woman at 34 weeks of pregnancy presented
to the hospital with continuous vaginal bleeding,
intrauterine fetal dead and acute abdominal pain. The
second case, a-30-year-old para 3 parous presented
to emergency room complaining of painful uterine
contractions; at 30 minutes after the hospitalization
the heart beat was no longer registered during nonstress
fetal monitoring; continuous bleeding and
uterine irritability followed. In both cases the fetus
was extracted by Caesarean section due to maternal
degradation and continuous bleeding; in the first
case a Caesarean hysterectomy was performed due
to uteroplacental apoplexy. Abnormal laboratory
tests recorded during the surgical intervention: under
1 gram/dl of fibrinogen and thrombocytes between
50 and 100000/ml, PT and APTT growth. In both
cases a red blood cell and plasma transfusion were
performed, as well as volemic balancing. In both
cases the outcome was favorable, the coagulation
normalized in less than 8 hours from procedure. In
conclusion, DIC may also appear before labor in
the third trimester when caused by uteroplacental
apoplexy and antepartum fetal death. The clinical
picture consisted in a pregnant woman presenting
with persistent vaginal bleedings, stiff uterus and
rapid deterioration of bodily function, requiring a
prompt management which included laboratory test
in order to differentiate a DIC diagnosis. In case of a
low probability of DIC diagnosis, a multisciplinary
team in an appropriate hospital with intensive care
unit and laboratory can lead to a favorable outcome. Cuvinte cheie: pregnancy, disseminated intravascular
coagulation, fibrinogen, intensive unit care.