Non-overt disseminated intravascular coagulation (DIC) in pregnancy: a new scoring system to identify patients at risk for obstetrical hemorrhage requiring blood product transfusion

Non-overt DIC is a subclinical hemostatic dysfunction that has not yet reached the decompensation stage. The detection of pregnant patients at this stage may assist in identifying those who will develop severe obstetrical hemorrhage, one of the leading causes of preventable maternal mortality. Currently, non-overt DIC is diagnosed by a scoring system based on non-pregnant patients, originally generated by the ISTH (International Society on Thrombosis and Hemostasis), which does not address physiologic changes of the hemostatic system during pregnancy.

Therefore, PRB investigators set out to develop a pregnancy-specific non-overt DIC score and determine the diagnostic accuracy of such score in detecting women at risk for obstetrical hemorrhage requiring blood product transfusion. More than 200 pregnant women comprised the study population. In all participants, the following hemostatic markers were measured: platelet count, prothrombin time difference, D-dimer, antithrombin III, fibrinogen, thrombin-antithrombin (TAT) complex, and protein C. The team found that a pregnancy-specific non-overt DIC score of 3 or more points at admission to delivery identified patients at risk for obstetrical hemorrhage requiring blood product transfusion with a sensitivity of 71.4%, and specificity of 77.9%. Such scoring system therefore has the potential to assist obstetricians in identifying patients at risk for major obstetrical hemorrhage so that necessary preventive measures may be employed.


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