PREVALENCE OF COAGULATION ABNORMALITIES ASSOCIATED WITH INTRAUTERINE FETAL DEATH

Purpose: The purpose of this study was to determine factors associated with abnormal coagulation in the setting of intrauterine fetal death (IUFD). Methods: We reviewed the charts of 238 patients diagnosed with IUFD over ten years. Data included demographics, coexisting obstetric disease and coagulation studies. A coagulation score was assigned bas ed on the platelet count, prothrombin time, activated partial thrombop lastin time and plasma fibrinogen concentration. Approximately 90% of the study population had coagulation scores < 4. A score of greater th an or equal to 4 was considered abnormal. Results: Complete coagulatio n analysis was available in 183/238 patients (77%) within 24 hr of del ivery. One hundred and sixty-four of these (89.6%) had a coagulation s core < 4 and 19 had a score greater than or equal to 4 (10.4%). No rel ationship between the coagulation score and age, parity gestational ag e at delivery, and number of days the dead fetus remained in utero was found. A coagulation score greater than or equal to 4 was associated with the presence of a pregnancy-related disease (P < 0.05), notably a bruption (P < 0.001) and uterine perforation (P < 0.05). Four patients without co-existing disease (3.2%), had a coagulation score greater t han or equal to 4. Conclusion: In most pregnancies complicated by feta l demise, the fetus and placenta are delivered within one week of feta l demise. The previously reported severe coagulation disturbances are largely eliminated by early delivery. Our study shows that coagulation abnormalities occur in some patients with uncomplicated IUFDs (3.2%) and that this number rises in the presence of abruption or uterine per foration.