Diagnosis and management of acute obstetrical DIC

Obstetrical disseminated intravascular coagulation (DIC) is usually a very acute, serious complication of pregnancy. The DIC diagnostic criteria in ob stetrics (the obstetrical DIC score) help with making a prompt diagnosis an d starting treatment early. These DIC diagnostic criteria, in which higher scores are given for clinical parameters than for laboratory parameters, ha ve three components: (1) the underlying disease, (2) clinical symptoms, and (3) laboratory findings. It is justified that it is appropriate to initiat e therapy for DIC when the obstetrical DIC score reaches 8 points or more b efore obtaining the results of coagulation tests. Management: (1) Control o f the underlying disease: because prolongation of exposure to the triggerin g factors worsens DIG, it is important to eliminate the etiologic factors a s rapidly as possible. Elimination of the cause of DIC can be easily perfor med in obstetrics, for example, by cesarean section. (2) Antithrombin (AT) therapy: AT monotherapy (1500 to 3000 units/day, 2 days) is preferably empl oyed instead of heparin monotherapy or heparin-AT therapy because of the he morrhagic side effects of heparin. (3) Synthetic serine protease inhibitors : continuous infusion of gabexate mesilate (FOY (R)) or nafamostat mesilate (FUT (R)) is effective for DIG. Controlled multicenter trials showed a sig nificant improvement not only in clinical response but also in platelet cou nts and prothrombin time (PT) in the AT group compared with the FOY group. (4) Activated protein C (APC) can inhibit thrombin generation and accelerat e fibrinolytic activity. APC (5000 to 10,000 units) is administered for 2 d ays in patients with pla cental abruption complicated by DIG. APC is a very safe, effective, and useful agent for the treatment of DIC.