Transcript Case Scenarios of DIC

Case Scenarios of DIC
Dr. Jyoti Bhaskar
MD MRCOG
Director Lifecare IVF
Consultant Lifecare Centre and Pushpanjali Crosslay Hospital
Case 1
Mrs. S, 28 yrs old, G3 P2
 Uneventful antenatal period,
 Admitted at 41 weeks for IOL
 1mg 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 theatre
 Oxygen by mask till anaesthetist came
 2 14/16 G cannulae inserted.
 Sample taken for crossmatch,
Haemogram,Coagulation studies,
 Baseline KFT, LFT
 Immediate 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 counselled
 Hysterectomy done.
 Abdominal packing done with drains
 Shifted to ICU
 Blood 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 up
 Admitted for observation.
 Stable, no BPV, no signs of APH.

30 mts later , NST suspicious
 Decision for LSCS
 Coag profile normal, blood crossmatched
 On LSCS
Liquor clear, No blood in abdomen
Small RPC seen.
 Surgeon called to examine the rest of
abdomen

Abdomen closed
 Clear urine
 Shifted to recovery
 20 mts later , frank haematuria and
bruises all over

Same steps as before
 PT,Aptt deranged, FDP high,
 Same protocol
 No increase in BPV seen
 Increased 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 surgery
 Pt went into ATN – needed dialysis
 Recovered completely and 2 years had a
normal delivery.
