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.
