title: Overt disseminated intravascular coagulation in obstetric patients.
abstract: OBJECTIVE
  To determine the incidence, etiology and outcome of treatment in obstetric patients complicated by overt disseminated intravascular coagulation (DIC).
  
  
  METHODS
  Medical records of 25 obstetric patients with a diagnosis of DIC in Songklanagarind University Hospital from January 1993 to December 2005 were reviewed
  
  
  RESULTS
  The incidence of overt DIC was I per 1,355 deliveries. Median maternal age was 30 years (range 17-44 years). Median duration of hospital stay was 10 days (range 0-32 days). The main associated conditions included abruptio placentae in 6 patients (24%), pregnancy-induced hypertension (PIH) in 5 (20%), amniotic fluid embolism in 4 (16%), acute fatty liver of pregnancy (AFLP) in 4 (16%), and HELLP syndrome in 3 (12%). A definite diagnosis ofDIC was made in 8 patients (32%) with a median DIC score of 6 (range 5-7) and the remainder were clinically diagnosed with incomplete work-up. All patients received blood component replacement. Cesarean section was performed in 10 patients (40%) and hysterectomy in 9 patients (36%). Six patients died, giving a case mortality rate of 24%. Three were associated with amniotic fluid embolism and one of each with fulminant hepatitis, ALFP and HELLP syndrome. Thirteen of 24 fetuses (54%) died, most related to abruptio placentae (6/6, 100%), PIH (4/5, 80%), and amniotic fluid embolism (2/4, 50%).
  
  
  CONCLUSIONS
  Various pregnancy-related conditions will predispose to DIC development. Early diagnosis with prompt treatment, including a quick decision for surgical intervention, and eradication of predisposing conditions would minimize maternal morbidity and mortality.
authors.affiliation: Department of Obstetrics and Gynecology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla 90110, Thailand. ounjai.k@gmail.com
authors.forename: Ounjai
authors.initials: O
authors.lastname: Kor-anantakul
authors.forename: Arnuparp
authors.initials: A
authors.lastname: Lekhakula
mesh_terms: D000037:Abruptio Placentae; D000293:Adolescent; D000328:Adult; D004211:Disseminated Intravascular Coagulation / Q000175:diagnosis* / Q000209:etiology / Q000601:surgery; D005260:Female; D006785:Hospitals, University; D006801:Humans; D015994:Incidence; D007902:Length of Stay; D011247:Pregnancy; D011248:Pregnancy Complications; D011256:Pregnancy Outcome; D012189:Retrospective Studies; D012307:Risk Factors; D013785:Thailand; D016896:Treatment Outcome