Definitions
Which four laboratory tests should be ordered when suspecting DIC?
Fibrinogen (Clauss method
Platelet count
Prothrombin time (PT)
D-dimer / FDP
What are the 6 most common causes of DIC in pregnancy?
Placental abruption, amniotic fluid embolism, severe preeclampsia/HELLP syndrome, sepsis, acute fatty liver of pregnancy, and retained stillbirth.
placental abruption accounts for ~37% of DIC cases, followed by postpartum hemorrhage/hypovolemia (29%), preeclampsia/HELLP (14%), acute fatty liver of pregnancy (8%), sepsis (6%), and amniotic fluid embolism (6%)
What is the incidence of DIC In pregnancy?
3 per 10,000 deliveries in developed countries, though the rate varies internationally from 0.03% to 0.35% of pregnancies. In developing countries, the frequency is thought to be significantly higher.
When suspecting DIC, which two specialties should be immediately contacted?
Anesthesia and ICU!
Which federal agent is Dominic built like?
AN ICE AGENT!
What clinical signs would make you suspect DIC in an obstetric patient?
Obstetricspecific bleeding: Persistent, heavy vaginal hemorrhage unresponsive to uterotonics; failure of blood to clot in collection tubes (the "bedside clot test"); continued oozing from the uterine incision site during or after cesarean delivery; and bleeding from episiotomy or laceration repair sites.
Generalized mucocutaneous bleeding: Spontaneous gingival bleeding, epistaxis, petechiae, purpura, and ecchymoses — often appearing at sites of minimal trauma.
Oozing from procedural sites: Persistent bleeding from venipuncture sites, IV insertion sites, epidural catheter sites, urinary catheters, and surgical drains — this is often the earliest clinical sign noticed by the care team.
Internal hemorrhage: Gastrointestinal bleeding, hematuria, and in severe cases, intracranial hemorrhage.
What is the pathophysiology behind DIC in patients with placental abruption?
Premature separation of the placenta releases large amounts of tissue factor (thromboplastin) from the decidua and trophoblastic tissue into the maternal circulation, triggering massive activation of the extrinsic coagulation pathway.
What percentage of maternal deaths are associated with DIC?
up to 25% of maternal deaths are associated with DIC
What are the two fundamental principles of treating DIC In pregnancy?
Treating the underlying obstetric cause and providing aggressive supportive care with blood product replacement.
What City does Roberto refuse to go to?
Denver, Colorado!
Is there a role for serial trending of labs in the setting of DIC in obstetric patients?
Serial trending is essential: Dynamic changes (falling fibrinogen, declining platelets, rising PT) are more diagnostically valuable than single values, particularly in early/non-overt DIC
Can you describe the pathophysiology of DIC In pregnancy in patients with PPH?
Massive blood loss causes dilutional coagulopathy and consumption of clotting factors, and tissue hypoperfusion and ischemia-reperfusion injury promote endothelial glycocalyx degradation, amplifying coagulopathy through increased vascular permeability and further factor consumption.
DIC occurs how often in patients with placental abruption?
DIC occurs in >50% of patients with placental abruption or amniotic fluid embolism.
What is the threshold for administering cryoprecipitate?
Thresholds for cryoprecipitate administration range from fibrinogen <1–2 g/L depending on institutional protocols. Fibrinogen ≤1.5 g/L has been identified as a predictor of severe obstetric DIC and need for transfusion. Early cryoprecipitate use is particularly important in placental abruption and amniotic fluid embolism.
Where did both Sam and Delaney honeymoon (separately)?
HAWAII!
The 2025 ISTH update formally classifies DIC into which two phenotypes?
Thrombotic and hemorrhagic phenotypes, and this distinction is particularly relevant in obstetrics. Placental abruption and amniotic fluid embolism typically produce a hemorrhagic phenotype driven by massive tissue factor release and hyperfibrinolysis, while preeclampsia/HELLP tends toward a thrombotic phenotype with microangiopathic hemolysis and organ ischemia.
What is the pathophysiology of DIC in patients with pre-eclampsia/HELLP?
Endothelial dysfunction and microangiopathy: syncytiotrophoblast-derived extracellular vesicles activate platelets and the coagulation cascade, while an imbalance in angiogenic factors (elevated sFlt-1 and soluble endoglin) contributes to widespread microvascular thrombosis
What is the median hospital stay in patients with DIC in the ICU vs. those who don't have DIC?
DIC had a median total hospital stay of 14 days compared to 11 days in obstetric ICU patients without DIC
When should platelets be administered?
Transfuse if platelet count falls below 75,000/μL
Which of Dr. Gorman's pets requires a standing ovation when it's done hunting?
HER CAT!!
What is Viscoelastic hemostatic assay? (TEG/ROTEM)
Viscoelastic hemostatic assays provide results in 5–20 minutes compared to 40–60 minutes for conventional labs, making them valuable in acute obstetric hemorrhage progressing to DIC.
What is the pregnancy-specific modified ISTH DIC score?
A three-component scoring system that uses only platelet count, prothrombin time (PT) difference, and fibrinogen — with pregnancy-adapted thresholds — to diagnose overt DIC in pregnant women. A score of ≥26 points indicates overt DIC, with 88% sensitivity and a 96% specificity.
What are the most common organ complications of DIC in pregnancy?
Acute renal failure (32.2%) and respiratory failure (16.1%) being the most common organ complications.
When should FFP be administered?
Administer if PT/INR or aPTT is >1.5× normal.
After this week, where is Koraima flying to for vacation?
Punta cana (in Dominican Republic, island of hispaniola - shared with Haiti)