title: Intrapartum anti-disseminated intravascular coagulation therapy leading to successful vaginal delivery following intrauterine fetal death caused by placental abruption: a case report.
abstract: BACKGROUND
  Disseminated intravascular coagulation due to placental abruption with intrauterine fetal death is not uncommon. It can result in increased maternal mortality rates and the need for hysterectomy or greater transfusion volumes if the delivery is not completed within six to eight hours. However, consensus is lacking regarding the delivery approach for cases in which delivery is prolonged.
  
  
  METHODS
  A 37-year-old Japanese woman was transported to our tertiary center two and a half hours after the onset of labor because of a diagnosis of placental abruption with intrauterine fetal death at 40 weeks and three days' gestation. On arrival, although severe hypofibrinogenemia was observed, there was no external hemorrhage. Because her cervical canal dilation was good (Bishop score, 7), labor was induced using oxytocin. Anti-disseminated intravascular coagulation therapy was simultaneously started via transfusion. After her hypofibrinogenemia resolved, delivery progressed rapidly, and the fetus was delivered approximately 10 hours after the onset. To reduce postpartum hemorrhage, 6g of fibrinogen concentrate and tranexamic acid, an antifibrinolytic agent, were administered immediately before extraction of the dead fetus and placenta. Although the amount of intrapartum hemorrhage was 1824g, there was no abnormal bleeding after delivery, and our patient was discharged three days later.
  
  
  CONCLUSIONS
  In cases of placental abruption complicated with disseminated intravascular coagulation, intrapartum administration of coagulation factors can simultaneously promote effective labor and correct hypofibrinogenemia, enabling minimally invasive vaginal delivery.
authors.forename: Michiko
authors.initials: M
authors.lastname: Honda
authors.affiliation: Center of Maternal, Fetal and Neonatal Medicine, Saitama Medical Center, Saitama Medical University, 1981 Kamoda, Kawagoe, Saitama 350-8550, Japan. shige_m@saitama-med.ac.jp.
authors.forename: Shigetaka
authors.initials: S
authors.lastname: Matsunaga
authors.forename: Sumiko
authors.initials: S
authors.lastname: Era
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Takai
authors.forename: Kazunori
authors.initials: K
authors.lastname: Baba
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Seki
mesh_terms: D000037:Abruptio Placentae / Q000097:blood / Q000188:drug therapy*; D000328:Adult; D000933:Antifibrinolytic Agents / Q000008:administration & dosage*; D003029:Coagulants / Q000008:administration & dosage*; D036861:Delivery, Obstetric; D004211:Disseminated Intravascular Coagulation / Q000097:blood / Q000150:complications / Q000188:drug therapy*; D005260:Female; D005313:Fetal Death; D005340:Fibrinogen / Q000008:administration & dosage*; D006801:Humans; D011247:Pregnancy; D011250:Pregnancy Complications, Hematologic / Q000097:blood / Q000188:drug therapy*; D011263:Pregnancy Trimester, Third; D050497:Stillbirth; D014148:Tranexamic Acid / Q000008:administration & dosage*; D016896:Treatment Outcome
chemical_list: D000933:Antifibrinolytic Agents; D003029:Coagulants; D014148:Tranexamic Acid; D005340:Fibrinogen