title: Disseminated intravascular coagulation in the HELLP syndrome: how much do we really know?
abstract: The rate of disseminated intravascular coagulation (DIC) during pregnancy varies among nations from 0.03% to 0.35%. The existing reports suggest dissimilarity in the underlying mechanisms leading to DIC during gestation. While in developing countries preeclampsia and the HELLP syndrome are prevalent causes of DIC, the leading causes in the developed countries are placental abruption and postpartum hemorrhage. In different cohort studies, DIC is reported in about 12-14% of women with preeclampsia. Nevertheless, it has been suggested that in most cases these women also had a HELLP syndrome and that the occurrence of DIC in women who had only preeclampsia without manifestations of the HELLP syndrome is rare. The aims of this review are to: (1) highlight the mechanisms leading to DIC; (2) describe the changes in the coagulation system during this complication; and; (3) discuss the diagnostic tool and treatment modalities of DIC, in women who develop a HELLP syndrome.
authors.affiliation: a Department of Obstetrics and Gynecology , Haukeland University Hospital , Bergen , Norway.
authors.forename: Kjell
authors.initials: K
authors.lastname: Haram
authors.affiliation: b Department of Public Health and Primary Health Care , University of Bergen , Bergen , Norway.
authors.forename: Jan Helge
authors.initials: JH
authors.lastname: Mortensen
authors.affiliation: c Department of Obstetrics and Gynecology , Azienda Ospedaliera Universitaria Policlinico di Bari, School of Medicine, University of Bari "Aldo Moro" , Bari , Italy , and.|d Department of Obstetrics and Gynecology , Soroka University Medical Center, School of Medicine, Ben Gurion University of the Negev , Beer Sheva , Israel.
authors.forename: Salvatore Andrea
authors.initials: SA
authors.lastname: Mastrolia
authors.affiliation: d Department of Obstetrics and Gynecology , Soroka University Medical Center, School of Medicine, Ben Gurion University of the Negev , Beer Sheva , Israel.
authors.forename: Offer
authors.initials: O
authors.lastname: Erez
mesh_terms: D000037:Abruptio Placentae / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D004211:Disseminated Intravascular Coagulation / Q000150:complications* / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy*; D005260:Female; D017359:HELLP Syndrome / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*; D006801:Humans; D006473:Postpartum Hemorrhage / Q000453:epidemiology / Q000209:etiology / Q000628:therapy; D011225:Pre-Eclampsia / Q000453:epidemiology / Q000209:etiology / Q000628:therapy; D011247:Pregnancy
keywords: DIC; fibrinolysis; placental abruption; systemic inflammation