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Thromb Haemost 1968; 20(03/04): 444-456
DOI: 10.1055/s-0038-1651287
Originalarbeiten – Original Articles – Travaux Originaux
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Acute and Chronic “Defibrination” in Obstetrical Practice

M Verstraete M. D.
1   Laboratory of Bloodcoagulation, Department of Medicine, University of Leuven, Belgium
,
J Vermylen M. D.
1   Laboratory of Bloodcoagulation, Department of Medicine, University of Leuven, Belgium
› Author Affiliations
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Publication History

Publication Date:
27 June 2018 (online)

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Summary

In case thromboplastic material (amniotic fluid, tissue fragments, activated coagulation factors or certain bacterial products) enters the maternal circulation, excessive and diffuse intravascular coagulation often with secondary fibrinolysis will occur in a sufficient degree to decrease the fibrinogen concentration in the blood below the hemostatic level. If this disseminated coagulation is precipitous, blockade of the microcirculation and quick defibrination will result with shock and a definitive bleeding syndrome (amniotic fluid embolism, premature separation of placenta, septic abortion). In subacute and chronic situations (foeto-maternal blood passage in hetero-specific pregnancy, retention of death foetus, hydatiform mole) external bleeding is not necessarily overt and the correct diagnosis often remains undiscovered.

The laboratory diagnosis is difficult and more so as the clinical situation requires urgent therapy. The finding of reduced levels of some coagulation factors (factors IV, VIII) a low platelet count and the detection of products of fibrinolysis (fibrin split products) in the serum indicate the occurrence of disseminated intravascular coagulation.

Treatment will be different in chronic and acute cases but aims in both to eliminate rapidly the source of thromboplastin release. In acute cases of premature separation of the placenta, fibrinogen under cover of heparin can be administered and shock combated with agents increasing cardiac output and causing peripheral vasodilatation. In septic abortion immediate administration of antibiotics and hysterectomy are probably the best advice.

 

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