Obstetric Complications: Consumption Coagulopathy
Many disorders unique to pregnancy are associated with the development of disseminated intravascular coagulation (DIC). These conditions include preeclampsia, placental abruption, septic abortion, fetal death in utero, and amniotic fluid embolus. Although the basic underlying clinical entities are very different, the same basic haemostatic problem develops. The normal mechanisms which control and regulate coagulation are disrupted. Thrombin production becomes excessive and rampant clot formation proceeds. In defense, the fibrinolytic system is activated, producing excess quantities of plasmin, in an attempt to lyse the fibrin clots. The action of plasmin leads to the production of fibrin degradation products and further disruption of coagulation. The patients’ clinical manifestations of this haemostatic disorder, DIC, will depend on a combination of several factors: 1) the patient’s basic underlying disease process, 2) the rate and duration of the coagulation system activation, and 3) the dominance of either the coagulation or fibrinolytic process. In order to diagnose and treat such patients who develop DIC, it is most helpful to review the basic pathophysiologic mechanisms that lead to disseminated intravascular coagulation. Once this basic foundation for understanding the process of DIC is established, the diagnosis and treatment of DIC and the unique problems associated with each clinical entity can be addressed.
KeywordsClotting Factor Disseminate Intravascular Coagulation Obstetric Complication Fibrin Clot Placental Abruption
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