Case Scenarios of DIC

Dr. Jyoti BhaskarMD MRCOG

Director Lifecare IVF

Consultant Lifecare Centre and Pushpanjali Crosslay Hospital

Case 1

Mrs. S, 28 yrs old, G3 P2Uneventful antenatal period, Admitted at 41 weeks for IOL1mg PG gel inserted at 7 am, repeated

at 4pm.Mild pains – subsided – reassesed and

1.5 mg PG tablet reinserted at 2am.

Pt developed good strong pain, progressed and delivered at 6 am.

Placenta delivered complete, vaginal tears were being repaired.

Profuse bleeding per vaginum, pt dyspnoeic

Pulse 110 bpm, RR 30pm, BP 90/60

What would you do??

Call for Help

Midwife

Colleague – Junior, senior

Anaesthesist

Blood bank/ laboratory

Haematologist

GDA - Porter

Pt shifted immediately to theatreOxygen by mask till anaesthetist came2 14/16 G cannulae inserted.Sample taken for crossmatch,

Haemogram,Coagulation studies,Baseline KFT, LFTImmediate request for 4 units of PRBC, 2 FFP, 1 Platelet

Pt was intubated as in respiratory distress.

All uterotonics tried.Cervix, vagina explored.No let up in bleeding despite all

resuscitative/ restorative measures.Decision for hysterectomy – 2

consultants involved

Administration involved.Relatives counselledHysterectomy done.Abdominal packing done with drainsShifted to ICUBlood component replacement continued

Patient reclosed after 48 hrs when stable.

Total of 35 units of blood, 10 units of FFP and 2 units of platelet given

Patient survived.

Case 2

Mrs K, 26 yrs, G1, 37 wks uneventful pregnancy.

Met with car accident – wheel hit on the uterus.

Drove to hosp for a check upAdmitted for observation.Stable, no BPV, no signs of APH.

30 mts later , NST suspiciousDecision for LSCSCoag profile normal, blood crossmatchedOn LSCS Liquor clear, No blood in abdomen Small RPC seen.Surgeon called to examine the rest of

abdomen

Abdomen closedClear urineShifted to recovery20 mts later , frank haematuria and

bruises all over

Same steps as beforePT,Aptt deranged, FDP high, Same protocolNo increase in BPV seenIncreased abdominal distension.On USG – excessive fluid collection in

abdomen seen.Paracentesis done

Initially pt not intubated, but after 8 hrs needed ventilation.

Blood component replacement continued.

Did not need any other surgeryPt went into ATN – needed dialysisRecovered completely and 2 years had a

normal delivery.