What is the mortality rate of postpartum hemorrhage (PPH) due to disseminated intravascular coagulation (DIC)?

Mortality Rate of Postpartum Hemorrhage Due to DIC

The mortality rate of postpartum hemorrhage (PPH) specifically due to disseminated intravascular coagulation (DIC) is not precisely quantified in current literature, but maternal mortality from obstetric hemorrhage overall represents 8.4% of peripartum deaths in developed countries, with DIC being a leading contributor to these deaths. 1

Understanding the Mortality Context

The mortality data for PPH complicated by DIC must be understood within the broader context of obstetric hemorrhage outcomes:

• In developed countries, maternal mortality due to PPH approximates 0.03% of all deliveries 1
• Between 2013-2015 in France, maternal mortality from obstetrical hemorrhage represented 8.4% of all peripartum deaths 1
• Severe PPH (defined as blood loss exceeding 1000 mL) occurs in approximately 2% of deliveries 1

DIC-Specific Mortality Considerations

DIC in obstetrics remains a leading cause of maternal death when associated with massive postpartum hemorrhage. 2 The mortality risk is substantially elevated when DIC complicates PPH:

• Hypofibrinogenemia (fibrinogen <200 mg/dL) is the biomarker most predictive of severe PPH and is strongly associated with DIC development 1
• Fibrinogen levels below 1 g/L were found in 29% of non-survivors with DIC in severe bleeding cases 1
• Acute coagulopathy with COVID-19 in pregnancy demonstrated a hyperfibrinolytic DIC phenotype with bleeding tendency, though specific mortality rates were not reported 1

Survival Outcomes with Aggressive Management

Recent case series demonstrate that with optimal management, survival is achievable even in catastrophic scenarios:

• A case series of 10 women with severe obstetric hemorrhage and DIC over 7 years reported zero maternal deaths when aggressive surgical intervention (hysterectomy and pelvic packing) was employed early 3
• A single case report of massive PPH exceeding 20,000 mL with severe DIC (fibrinogen 65 mg/dL, platelets 6.0 × 10⁹/L) resulted in survival using damage control surgery 2
• In a tertiary hospital study of 352 parturients with PPH, 99.4% survived with aggressive blood product therapy, though the specific subset with DIC was not isolated 4

Critical Prognostic Factors

Plasma fibrinogen concentration is the only modifiable prepartum risk factor independently associated with progression to severe PPH and DIC. 4 Key predictive markers include:

• Fibrinogen <2 g/L with ongoing bleeding is associated with progression to massive obstetric hemorrhage 5
• FIBTEM A5 value <12 mm on viscoelastic testing can predict progression to severe hemorrhage 5
• Platelet counts <100 × 10⁹/L combined with elevated liver enzymes indicate severe coagulopathy 1

Geographic and Resource Disparities

The incidence and mortality of obstetric-related DIC varies dramatically by geographic region and resource availability:

• Higher mortality rates are reported in low-resource settings due to delayed diagnosis and management 6
• In the WOMAN trial conducted internationally, bleeding-related mortality was 1.5% with tranexamic acid versus 1.9% without (though this included all PPH, not DIC-specific cases) 1
• The WOMAN trial's mortality rates (1.9% for hemorrhage-related mortality in the placebo group) do not correspond to developed country rates where PPH mortality approximates 0.03% 1

Clinical Implications

Early recognition and aggressive intervention are paramount to preventing mortality from DIC-complicated PPH:

• Tranexamic acid 1 g IV should be administered within 3 hours of bleeding onset, with demonstrated reduction in bleeding-related mortality (RR 0.81,95% CI 0.65-1.00) 1, 5
• Early resort to hysterectomy when conservative measures fail minimizes maternal morbidity and mortality 3
• Damage control surgery with pelvic packing should be considered when oozing persists after hysterectomy due to severe DIC 2
• Point-of-care viscoelastic testing enables rapid assessment of coagulopathy and guides targeted blood component therapy 1, 5

Common Pitfalls to Avoid

• Do not underestimate blood loss through visual assessment; use calibrated measurement tools as visual estimation is often inaccurate 5
• Do not wait for laboratory results before initiating blood component therapy in severe bleeding with suspected DIC 5
• Do not delay hysterectomy when conservative measures fail, as this increases mortality risk 3
• Do not overlook fibrinogen monitoring, as hypofibrinogenemia is the most common factor deficiency in PPH and the strongest predictor of progression to severe hemorrhage 5, 4