Disseminated intravascular coagulation

Healthy pregnancy is accompanied by changes in the haemostatic system which convert it into a hypercoagulable state vulnerable to a spectrum of disord ers ranging from venous thromboembolism to disseminated intravascular coagu lation (DIC). This latter is always a secondary phenomenon triggered by spe cific disorders such as abruptio placentae and amniotic fluid embolism due to release of thromboplastin intravascularly or endothelial damage resultin g from pre-eclampsia and sepsis. In modern obstetric practice the most comm on cause is haemorrhagic shock with delay in resuscitation leading to endot helial damage. The initial management of massive obstetric haemorrhage is t he same whether associated with coagulopathy initially or not. Low-grade DI C, associated with pre-eclampsia, is monitored haematologically by serial p latelet counts and serum fibrin degradation products (FDPs). Supportive mea sures and removal of the triggering mechanism are the key to successful man agement. Outcome depends primarily on our ability to deal with the trigger and not on direct attempts to correct the coagulation deficit.