DIC in pregnancy presents a major management challenge, particularly when the fetus is viable or near viability. DIC occurs in 1-5% of pregnancies and is most often caused by placental abruption, preeclampsia, or amniotic fluid embolism. Pregnancy induces a hypercoagulable state through increased coagulation factors and platelet activity as well as decreased anticoagulation and fibrinolysis, serving to prevent excessive bleeding during childbirth. Non-obstetric causes of DIC during pregnancy include primary thrombotic microangiopathy, von Willebrand disease, and antiphospholipid syndrome.

1. DIC IN PREGNANCY

2. Dillema
 Major management challenge
 Further complicated when the patient is carrying a fetus at or beyond the
limit of viability.
 To transfuse a pregnant patient with DIC who is bleeding heavily or
performing an emergency cesarean delivery on a pregnant patient with
catastrophic hemorrhage.

3.  Accounts for approximately 1 to 5 percent of all cases of DIC
 Prevalence ranges from 0.03 to 0.35 percent of all delivery hospitalizations in
population-based studies .
 Patients with specific pregnancy complications, such as placental abruption or
amniotic fluid embolism, can be at very high risk (eg, prevalence >20 percent)

4. PATHOPHYSIOLOGY
 Pregnancy is a hypercoagulable state .
 The shift in the balance between the hemostatic and fibrinolytic systems
serves to prevent excessive bleeding during placental separation
 Marked increases in most coagulation factors
 Decreased endogenous anticoagulation
 Reduced fibrinolysis
 Increased platelet reactivity.

5. CAUSES
 Placental abruption
 Preeclampsia with severe features/eclampsia/HELLP syndrome (hemolysis,
elevated liver enzymes, low platelets)
 Amniotic fluid embolism
 Acute fatty liver of pregnancy
 Septic abortion
 Non Obstetric causes

6.  PPH with dilutional coagulopathy
 primary thrombotic microangiopathy
 von Willebrand disease
 antiphospholipid syndrome
 pulmonary embolism
 heparin-induced thrombocytopenia
 transfusion reaction