What amount of blood loss precedes Disseminated Intravascular Coagulation (DIC) in pregnancy?

From the Guidelines

Disseminated Intravascular Coagulation (DIC) in Pregnancy

The development of Disseminated Intravascular Coagulation (DIC) in pregnancy is typically associated with significant blood loss, estimated to be in excess of 1.5 to 2 liters 1. This degree of hemorrhage can lead to a cascade of coagulopathic events, resulting in the consumption of clotting factors and the subsequent activation of the coagulation and fibrinolytic pathways.

• Key factors that contribute to the development of DIC in pregnancy include:
  • Severe bleeding: Blood loss of more than 1,500 mL can lead to coagulopathy and increase the risk of DIC 1.
  • Obstetric complications: Conditions such as placental abruption, uterine rupture, or postpartum hemorrhage can cause significant blood loss and increase the risk of DIC 1.
• Management of DIC in pregnancy may involve:
  • Transfusion of blood products: Packed red blood cells, fresh frozen plasma, and platelets may be transfused in a fixed ratio to replace lost blood and clotting factors 1.
  • Medications: Tranexamic acid may be administered to help control bleeding, typically at a dose of 1 gram intravenously over 10 minutes, repeated as needed.
• It is essential to treat the patient based on clinical presentation and not wait for laboratory results, as well as to keep the patient warm and rapidly transfuse blood products as needed 1.

From the Research

Disseminated Intravascular Coagulation (DIC) in Pregnancy

• DIC is a syndrome that can be initiated by various medical, surgical, and obstetric disorders, including placental abruption, amniotic fluid embolism, sepsis syndrome, and acute fatty liver of pregnancy 2.
• The etiopathogenesis of DIC is complex and involves the activation of the coagulation sequence, leading to fibrin clotting and its dissolution by the fibrinolysin system 2.
• Obstetric disorders associated with DIC include severe preeclampsia, hemolysis, elevated liver enzymes, and low platelet count syndrome, and massive obstetric hemorrhage 2, 3.

Blood Loss and DIC in Pregnancy

• Massive obstetric hemorrhage is a common cause of DIC in pregnancy, and treatment of DIC is centered on identifying and treating the underlying disorder, as well as controlling obstetric complications such as uterine atony or lacerations 2.
• A study found that 35.8% of patients with postpartum hemorrhage had overt DIC, with a median DIC score of 37.0, and that blood transfusion was unnecessary in 64.1% of patients 4.
• The amount of blood loss that precedes DIC in pregnancy is not explicitly stated in the studies, but it is clear that massive obstetric hemorrhage is a significant risk factor for DIC 2, 3, 5.

Diagnosis and Management of DIC in Pregnancy

• The diagnosis of DIC is complicated due to physiological changes during late pregnancy and the postpartum period, and a pregnancy-modified DIC score has been constructed to aid in diagnosis 4.
• Treatment of DIC should focus on identifying and treating the underlying cause, as well as providing supportive treatment individualized to the patient's symptoms and laboratory records 6.
• Prompt diagnosis and understanding of the underlying mechanisms of disease leading to DIC are essential for a favorable outcome 3, 5.