Obstetrics, Gynecology and Reproduction

Advanced search

Disseminated intravascular coagulation in perinatal medicine

Full Text:


Introduction. Disseminated intravascular coagulation (DIC) is an acquired syndrome characterized by intravascular activation of blood clotting without specific localization and arising from various causes. DIC is the most complex and high-priority problem in contemporary clinical medicine including obstetrics and perinatology. DIC significance is related to its peak perinatal mortality, as well as a large rate of complications during childbirth and postpartum period.

Aim: to conduct comprehensive data assessment related to DIC pathogenesis and management in pregnant women and newborns.

Materials and methods. A search for DIC-related publications within the past 10 years was conducted in international research databases: Scientific Electronic Library Online eLibrary, Google Scholar, ScienceDirect, Cochrane Library, PubMed/Medline. The data regarding DIC diagnostic criteria and markers, as well as current approach to its treatment are presented.

Results. DIC may be considered as one of the causes resulting in massive obstetric bleeding. The majority of pregnancy-related complications is manifested as preeclampsia, premature detachment of normally situated placenta and anaphylactoid syndrome of pregnancy. Any massive bleeding should be perceived as hemorrhage resulting from the DIC progression.

Conclusion. Knowledge of the DIC pathogenetic mechanisms is necessary for conducting a differential diagnosis and applying timely treatment.

About the Authors

M. A. Mingalimov
Sechenov University
Russian Federation

Marat A. Mingalimov - 6th year Student.

62 St. Zemlyanoi Val, Moscow 109004

K. N. Grigorieva
Sechenov University
Russian Federation

Kristina N. Grigoreva - 6th year Student, Faculty of Pediatrics.

62 St. Zemlyanoi Val, Moscow 109004

M. V. Tretyakova
Medical Center, LLC
Russian Federation

Maria V. Tretyakova - PhD, Obstetrician-Gynecologist, Department of Gynecology.

15/1 Timura Frunze St., Moscow 119021

I. Elalamy
Sechenov University; Medicine Sorbonne University; HospitaI Tenon

Ismail Elalamy - MD, PhD, Professor, Department of Obstetrics and Gynecology, Institute of Children's Health, SU; Professor, MSU; Director of Hematology, Department of Thrombosis Center, Hospital Tenon, Scopus Author ID: 7003652413, Researcher ID: AAC-9695-2019.

Kh. G. Sultangadzhieva
Sechenov University
Russian Federation

Khadizhat G. Sultangadzhieva - Postgraduate Student, Department of Obstetrics and Gynecology, Institute of Children's Health.

62 St. Zemlyanoi Val, Moscow 109004

V. O. Bitsadze
Sechenov University
Russian Federation

Victoria O. Bitsadze - MD, Dr Sci Med, Professor, Department of Obstetrics and Gynecology, Institute of Children's Health, Scopus Author ID: 6506003478, Researcher ID: F-8409-2017.

62 St. Zemlyanoi Val, Moscow 109004

J. Kh. Khizroeva
Sechenov University
Russian Federation

Jamilya Kh. Khizroeva - MD, Dr Sci Med, Professor, Department of Obstetrics and Gynecology, Institute of Children's Health.

62 St. Zemlyanoi Val, Moscow 109004

A. D. Makatsariya
Sechenov University
Russian Federation

Alexander D. Makatsariya - MD, Dr Sci Med, Professor, Academician of RAS, Head of the Department of Obstetrics and Gynecology, Institute of Children's Health, Scopus Author ID: 6602363216, Researcher ID: M-5660-2016.

62 St. Zemlyanoi Val, Moscow 109004


1. Zyyatdinov K.Sh., Belopukhov V.M., Yakupov I.F. et al. Disseminated intravascular coagulation syndrome in myocardial infarction. [Sindrom disseminirovannogo vnutrisosudistogo svertyvaniya pri infarkte miokarda]. Vestnik sovremennoj klinicheskoj mediciny. 2014;7(5):34— 9. (In Russ.).

2. Makatsariya A.D., Panfilova O.Yu. On the issue of DIC-syndrome in obstetrics: new on the old one. [K voprosu o DVS-sindrome v akusherstve: novoe o starom]. Prakticheskaya medicina. 2010;(4):25— 37. (In Russ.).

3. Trousseau A. Phlegmasia alba dolens. Clin Med Hotel Dieu Paris. 1865;3:695.

4. Ratnoff O.D., Pritchard J.A., Colopy J.E. et al. Hemorrhagic states during pregnancy. N Engl J Med. 1955;253(3):97—102. DOI: 10.1056/NEJM195507212530305.

5. Lasch H.G., Heene D.L., Huth K., Sandritter W. Pathophysiology, clinical manifestations and therapy of consumption-coagulopathy («Verbrauchskoagulopathie»). Am J Cardiol. 1967;20(3):381—91. DOI: 10.1016/0002-9149(67)90062-8.

6. . McKay D.G. Disseminated intravascular coagulation: an intermediary mechanism of disease. New York: Hoeber Medical Division of Harper and Row, 1965. 392 p.

7. Lisman T., Luyendyk J.P. Platelets as modulators of liver disease. Semin Thromb Hemost. 2018;44(2):114—25. DOI: 10.1055/s-0037-1604091.

8. Abbassi-Ghanavati M., Greer L.G., Cunningham F.G. Pregnancy and laboratory studies: a reference table for clinicians. Obstet Gynecol. 2009;114(6):1326—31. DOI: 10.1097/AOG.0b013e3181c2bde8.

9. Levi M., Ten Cate H. Disseminated intravascular coagulation. N Engl J Med. 1999;341(8):586—92. DOI: 10.1056/NEJM199908193410807.

10. Uszynski M., Zekanowska E., Uszyński W., Kuczyński J. Tissue factor (TF) and tissue factor pathway inhibitor (TFPI) in amniotic fluid and blood plasma: implications for the mechanism of amniotic fluid embolism. Eur J Obstet Gynecol Reprod Biol. 2001;95(2):163—6. DOI: 10.1016/s0301-2115(00)00448-6.

11. Boer K., den Hollander I.A., Meijers J.C., Levi M. Tissue factor-dependent blood coagulation is enhanced following delivery irrespective of the mode of delivery. J Thromb Haemost. 2007;5(12):2415—20. DOI: 10.1111/j.1538-7836.2007.02767.x.

12. Williams obstetrics. Eds. F. Cunningham, K.J. Leveno, S.L. Bloom et al. 25th ed. New York (NY): McGraw-Hill, 2018. 1328 p.

13. Kuczynski J., Uszyński W., Zekanowska E. et al. Tissue factor (TF) and tissue factor pathway inhibitor (TFPI) in the placenta and myometrium. Eur J Obstet GynecolReprod Biol. 2002;105(1):15—9. DOI: 10.1016/s0301-2115(02)00113-6.

14. Pritchard J.A., Brekken AL. Clinical and laboratory studies on severe abruptio placentae. Am J Obstet Gynecol. 1967;97(5):681—700. DOI: 10.1016/0002-9378(67)90454-1.

15. Makatsariya A.D., Panfilova O.Yu. Amniotic fluid embolism or anaphylactoid syndrome of pregnancy. [Emboliya okoloplodnymi vodami ili anafilaktoidnyj sindrom beremennosti]. Prakticheskaya medicina. 2010;(43):13—9. (In Russ.).

16. Clark S.L. Amniotic fluid embolism. Obstet Gynecol. 2014;123(2 Pt 1):337—48. DOI: 10.1097/A0G.0000000000000107.

17. Nelson D.B., Yost N.P., Cunningham F.G. Hemostatic dysfunction with acute fatty liver of pregnancy. Obstet Gynecol. 2014;124(1):40—6. DOI: 10.1097/A0G.0000000000000296.

18. Sibai B.M. Imitators of severe preeclampsia. Obstet Gynecol. 2007;109(4):956--66. DOI: 10.1097/

19. Vigil-de Gracia P., Montufar-Rueda C. Acute fatty liver of pregnancy: diagnosis, treatment, and outcome based on 35 consecutive cases. J Matern Fetal Neonatal Med. 2011;24(9):1143-6. DOI: 10.3109/14767058.2010.531325.

20. Russell J.A. Management of sepsis. N Engl J Med. 2006;355(16):1699— 713. DOI: 10.1056/NEJMra043632.

21. Moellering R.C., Abbott G.F., Ferraro M.J. Case records of the Massa-chussets General Hospital Case 2-2011. A 30-year-old woman with shock after treatment for a furuncle. N Engl J Med. 2011;364(3):266-75. DOI: 10.1056/NEJMcpc1003886.

22. Mabie W.C., Barton J.R., Sibai B. Septic shock in pregnancy. Obstet Gynecol. 1997;90(4 Pt 1):553-61. DOI: 10.1016/s0029-7844(97)00352-9.

23. Barton J.R., Sibai B.M. Severe sepsis and septic shock in pregnancy. Obstet Gynecol. 2012;120(3):689—706. DOI: 10.1097/AOG.0b013e318263a52d.

24. Sheffield J.S., Cunningham F.G. Urinary tract infection in women. Obstet Gynecol. 2005;106(5 Pt 1):1085-92. DOI: 10.1097/01.AOG.0000185257.52328.a2.

25. Wenzel R.P., Edmond M.B. Septic shock-evaluating another failed treatment. N Engl J Med. 2012;366(22):2122-4. DOI: 10.1056/NEJMe1203412.

26. Hypertensive disorders in pregnancy. Ed. L.C. Chesley. New York (NY): Appleton-Century-Crofts, 1978. 628 p.

27. Pritchard J.A., Cunningham F.G., Mason R.A. Coagulation changes in eclampsia: their frequency and pathogenesis. Am J Obstet Gynecol. 1976;124(8):855—64. DOI: 10.1016/s0002-9378(16)33390-7.

28. Jimenez J.M., Pritchard J.A. Pathogenesis and treatment of coagulation defects resulting fetal death. Obstet Gynecol. 1968;32(4):449-59.

29. Kramer M.S., Berg C., Abenhaim H. et al. Incidence, risk factors, and temporal trends in severe postpartum hemorrhage. Am J Obstet Gynecol. 2013;209(5):449.e1-7. DOI: 10.1016/j.ajog.2013.07.007.

30. Erez O., Novack L., Beer-Weisel R. et al. DIC score in pregnant women - a population based modification of the International Society on Thrombosis and Hemostasis score. PLoS One. 2014;9(4):e93240. DOI: 10.1371/journal.pone.0093240.

31. Roberts I., Murray N.A. Neonatal thrombocytopenia: causes and management. Arch Dis Child Fetal Neonatal Ed. 2003;88(5):F359-64. DOI: 10.1136/fn.88.5.F359.

32. Levi M., Toh C.H., Thachil J., Watson H.G. Guidelines for the diagnosis and management of disseminated intravascular coagulation. British Committee for Standards in Haematology. Br J Haematol. 2009;145(1):24-93. DOI: 10.1111/j.1365-2141.2009.07600.x.

33. Levi M., Meijers J.C. DIC: which laboratory tests are most useful. Blood Rev. 2011;25(1):33-7. DOI: 10.1016/j.blre.2010.09.002.

34. Momot A.P., Mamaev A.N. Current aspects of the pathogenesis, diagnosis and therapy of DIC. [Sovremennye aspekty patogeneza, diagnostic i terapii DVS-sindroma]. Klinicheskaya onkogematologiya. Funda-mental’nye issledovaniya iklinicheskaya praktika. 2008;1(1):63-71. (In Russ.).

35. Hunt B.J. Bleeding and coagulopathies in critical care. N Engl J Med. 2014;370(9):847-59. DOI: 10.1056/NEJMra1208626.

36. Josic D., Hoffer L., Buchacher A. et al. Manufacturing of a prothrombin complex concentrate aiming at low thrombogenicity. Thromb Res. 2000;100(5):433-41. DOI: 10.1016/S0049-3848(00)00339-X.

37. Kreuz W., Meili E., Peter-Salonen K. et al. Efficacy and tolerability of a pasteurized human fibrinogen concentrate in patients with congenital fibrinogen deficiency. Transfus Apher Sci. 2005;32(2):247-53. DOI: 10.1016/j.transci.2004.08.003.

38. Weinkove R., Rangarajan S. Fibrinogen concentrate for acquired hypofibrinogenaemic states. Transfus Med. 2008;18(3):151-7. DOI: 10.1111/j.1365-3148.2008.00854.x.

39. Corrigan J.J., Jordan C.M. Heparin therapy in septicemia with disseminated intravascular coagulation. N Engl J Med. 1970;283(15):778-82. DOI: 10.1056/NEJM197010082831502.

40. Kobayashi T., Teraro T., Ikenoue T. et al. B151017 Study Group. Treatment of severe preeclampsia with antithrombin concentrate: results of a prospective feasibility study. Semin Thromb Hemost. 2003;29(6):645-52. DOI: 10.1055/s-2004-815632.

41. Bernard G.R., Vincent J.L., Laterre P.F. et al. Efficacy and safety of recombinant human activated protein C for severe sepsis. N Engl J Med. 2001;344(10):699-709. DOI: 10.1056/NEJM200103083441001.

42. Edwards H.M. Aetiology and treatment of severe postpartum haemorrhage. Dan Med J. 2018;65(3). pii: B5444.


For citations:

Mingalimov M.A., Grigorieva K.N., Tretyakova M.V., Elalamy I., Sultangadzhieva K.G., Bitsadze V.O., Khizroeva J.K., Makatsariya A.D. Disseminated intravascular coagulation in perinatal medicine. Obstetrics, Gynecology and Reproduction. 2020;14(1):56-68. (In Russ.)

Views: 967

ISSN 2313-7347 (Print)
ISSN 2500-3194 (Online)