title: Disseminated intravascular coagulation and massive obstetric hemorrhage. Management dilemma.
abstract: OBJECTIVE
  The objective of this retrospective study is to reflect on our experience on an optimal management for major postpartum hemorrhage, which would prevent the occurrence and complications of disseminated intravascular coagulation and minimize maternal mortality and morbidity.
  
  
  METHODS
  Ten cases out of the 30,000 of total deliveries of severe obstetric hemorrhage associated with disseminated intravascular coagulation were studied. This study was carried out over a 7 year period, October 1988 through to September 1995, at the Obstetric Unit, King Khalid University Teaching Hospital, Riyadh, Kingdom of Saudi Arabia.
  
  
  RESULTS
  All of the 10 women received packed red blood cells, 8 had fresh frozen plasma, and 6 received platelet transfusion. The 10 cases developed disseminated intravascular coagulation following medical and surgical management, all women needed hysterectomy, 4 subtotal, 6 total, and 5 women had relaparotomy and pelvic packing. Two had bladder injuries. There was no maternal death.
  
  
  CONCLUSIONS
  An early resort to hysterectomy when conservative measures fail, will minimize maternal morbidity and mortality. In case of continuous bleeding after hysterectomy, pelvic packing proved to be effective.
authors.affiliation: Department of Obstetrics & Gynecology, College of Medicine and King Khalid University Hospital, King Saud University, Riyadh, Kingdom of Saudi Arabia.
authors.forename: Lulu A
authors.initials: LA
authors.lastname: Al-Nuaim
authors.forename: Mohamed S
authors.initials: MS
authors.lastname: Mustafa
authors.forename: Abdel Galil M
authors.initials: AG
authors.lastname: Abdel Gader
mesh_terms: D000328:Adult; D004211:Disseminated Intravascular Coagulation / Q000401:mortality / Q000628:therapy*; D005260:Female; D006801:Humans; D007044:Hysterectomy; D006473:Postpartum Hemorrhage / Q000628:therapy*; D012189:Retrospective Studies; D012529:Saudi Arabia / Q000453:epidemiology