title: Desmopressin-induced Moschcowitz-like syndrome after treatment of uterine atonic bleeding in a 28-year-old pregnant woman:  case report and overview of the literature.
abstract: Here we report of a patient who developed a Moschcowitz-like syndrome following a desmopressin treatment of severe postpartum hemorrhage. The patient got an anaphylactic reaction after cervical ripening with dinoproston, leading to an emergency cesarean. A postpartum uterine atony with a blood loss more than 1500 ml resulted in a disseminated intravascular coagulation that was treated with mass transfusion of blood products, including platelets and factor VII. Desmopressin is used as rescue medication in situations of severe bleeding. It was given in this life-threatening situation and presumably triggered a Moschcowitz-like syndrome. Desmopressin exerts its haemostatic effect by releasing von Willebrand factor, which is elevated in pregnancy per se. This results in an increased risk of developing microthrombi, leading to a Moschcowitz-like syndrome. In conclusion, desmopressin should not be administered in pregnant patients owing to its potential risk of triggering the development of thrombotic-thrombocytopenic purpura.
authors.affiliation: Department of Obstetrics and Gynecology, Südstadt Hospital, University of Rostock, Germany. max.dieterich@uni-rostock.de
authors.forename: Max
authors.initials: M
authors.lastname: Dieterich
authors.forename: Ellen
authors.initials: E
authors.lastname: Mann
authors.forename: Klaus F
authors.initials: KF
authors.lastname: Wagner
authors.forename: Beate
authors.initials: B
authors.lastname: Kramer-Steiner
authors.forename: Toralf
authors.initials: T
authors.lastname: Reimer
authors.forename: Bernd
authors.initials: B
authors.lastname: Gerber
authors.forename: Johannes
authors.initials: J
authors.lastname: Stubert
mesh_terms: D000328:Adult; D001803:Blood Transfusion; D002585:Cesarean Section; D003894:Deamino Arginine Vasopressin / Q000008:administration & dosage / Q000009:adverse effects*; D015232:Dinoprostone / Q000008:administration & dosage*; D004211:Disseminated Intravascular Coagulation / Q000097:blood* / Q000150:complications / Q000188:drug therapy; D005260:Female; D006490:Hemostatics / Q000008:administration & dosage / Q000009:adverse effects; D006801:Humans; D010120:Oxytocics / Q000008:administration & dosage; D006473:Postpartum Hemorrhage / Q000097:blood* / Q000188:drug therapy; D011247:Pregnancy; D011697:Purpura, Thrombotic Thrombocytopenic / Q000097:blood* / Q000150:complications / Q000188:drug therapy; D014593:Uterine Inertia / Q000097:blood* / Q000188:drug therapy; D014841:von Willebrand Factor / Q000008:administration & dosage
chemical_list: D006490:Hemostatics; D010120:Oxytocics; D014841:von Willebrand Factor; D003894:Deamino Arginine Vasopressin; D015232:Dinoprostone