Chapter: Clinical Cases in Anesthesia : Abruptio Placenta and Placenta Previa
What is disseminated intravascular coagulopathy and how is it managed?
What is
disseminated intravascular coagulopathy and how is it managed?
DIC is characterized by activation of systemic
coagula-tion leading to consumption of clotting factors and activation of
secondary fibrinolysis. This will result in hypofibrinogenemia,
thrombocytopenia, and the produc-tion of fibrin degradation products. The
clinical presentation is marked by hemorrhage, lack of clot formation, and
bleeding from all puncture sites, such as intravenous insertion sites. Abnormal
laboratory values include elevation in prothrombin time (PT), partial
thromboplastin time (PTT), low platelet count, and fibrinogen level (Table
61.3).
Successful treatment of DIC requires removal of
the source, i.e., delivery of the fetus and placenta. In addition to delivery,
treatment of the coagulopathy with fresh frozen plasma, cryoprecipitate, for
fibrinogen replacement, and platelets will be necessary until the process
begins to reverse.
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