Pathogenesis and management of peripartum coagulopathic calamities (disseminated intravascular coagulation and amniotic fluid embolism)

Acute coagulopathic peripartum calamities are relatively rare but contribute importantly to maternal morbidity and mortality in the Western world. Abruptio placenta, amniotic fluid embolism, and retained fetal or placental material may lead to fulminant intravascular activation of coagulation which...

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Bibliographic Details
Published in:	Thrombosis research Vol. 131; pp. S32 - S34
Main Author:	Levi, Marcel
Format:	Journal Article
Language:	English
Published:	United States Elsevier Ltd 01.01.2013
Subjects:	Abruptio Placentae - diagnosis Abruptio Placentae - physiopathology Amniotic Fluid - metabolism Amniotic fluid embolism Anticoagulants - therapeutic use Blood Coagulation Coagulation Disseminated intravascular coagulation Disseminated Intravascular Coagulation - physiopathology Disseminated Intravascular Coagulation - therapy Embolism, Amniotic Fluid - physiopathology Embolism, Amniotic Fluid - therapy Female Hematology, Oncology and Palliative Medicine Humans Insulin-Like Growth Factor Binding Protein 1 - metabolism Placenta - metabolism Pregnancy Pregnancy Complications, Hematologic - diagnosis Pregnancy Complications, Hematologic - physiopathology Pregnancy Complications, Hematologic - therapy Risk Factors Pregnancy Disseminated intravascular coagulation Amniotic fluid embolism Coagulation
ISSN:	0049-3848, 1879-2472, 1879-2472
Online Access:	Get full text
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Summary:	Acute coagulopathic peripartum calamities are relatively rare but contribute importantly to maternal morbidity and mortality in the Western world. Abruptio placenta, amniotic fluid embolism, and retained fetal or placental material may lead to fulminant intravascular activation of coagulation which results in thromboembolic complications and consumption coagulopathy causing severe hemorrhage. The central underlying pathophysiological pathway in the coagulopathy associated with these syndromes is the occurrence of tissue factor, released from the placenta and amniotic fluid, in the circulation, in combination with low levels of physiological anticoagulant factors during pregnancy. The diagnosis of DIC may be made trough conventional composite scoring systems employing routine coagulation tests, whereas for the diagnosis of amniotic fluid embolism measurement of insulin like growth factor binding protein-1 seems promising. Therapy is aimed at removing the precipitating factor combined with supportive adjunctive treatment options.
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ISSN:	0049-3848 1879-2472 1879-2472
DOI:	10.1016/S0049-3848(13)70017-3