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Query: UMLS:C0012739 (disseminated intravascular coagulation)
 8,673 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Amniotic fluid embolism is a catastrophic event of the intra- and early postpartum period which may also be seen with cesarean delivery and during abortions. Presenting symptomatology includes respiratory distress with cyanosis, shock, and possibly tonic-clonic seizures. DIC frequently occurs. The pathogenesis may include entry of amniotic fluid through lacerations or ruptures of the uterus or cervix, through endocervical veins and through abnormal uteroplacental sites, such as with placental abruption, placenta previa, or placenta accreta. Amniotic fluid probably causes cardiovascular-respiratory symptoms by pulmonary vascular obstruction and through a vasoactive substance causing pulmonary vascular constriction. The lethality of amniotic fluid may be enhanced by a high particulate content or meconium staining. The diagnosis of amniotic fluid embolism may be made ante mortem by demonstrating amniotic fluid debris in central blood samples or expectorated sputum. Postmortem diagnosis often requires meticulous examination of the pulmonary microvasculature with the utilization of special stains. Treatment is directed towards symptoms of shock, arterial hypoxemia, and DIC. Acute renal failure may complicate the picture after shock. If the patient survives the embolic and coagulative problems, recovery is usually complete without long-term sequelae.
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PMID:Amniotic fluid embolism. Three case reports with a review of the literature. 402 76

The clinico-pathological features of four patients with placental-site trophoblastic tumour (trophoblastic pseudotumour) are presented. One patient had the nephrotic syndrome associated with evidence of disseminated intravascular coagulation, with complete resolution after hysterectomy. In two patients the tumour extended beyond the uterus, and one of them died with many metastases in spite of intensive post-operative chemotherapy and 'second look' laparotomy. In three patients the tumour behaved as an actively infiltrative neoplasm resistant to chemotherapeutic regimes usually effective for choriocarcinoma. Serum HCG levels were relatively low compared with those of choriocarcinoma. Histologically the tumours were predominantly composed of mononuclear cells supported by a variable amount of vascular stroma and lacked the bilaminar structure characteristic of choriocarcinoma. Scattered cells stained positively with anti-beta HCG and anti-alpha HCG antisera. Prior curettage was diagnostic in two of three cases. We did not find a clear correlation between mitotic activity and subsequent behaviour. Inflammatory cell infiltration and evidence of organisation around the tumour may be favourable prognostic indicators. We agree with a recent publication stressing the variable behaviour of this tumour, and emphasize the importance of serum HCG monitoring. Total surgical excision is usually feasible and in aggressive cases offers the best chance of eradication. We support the recent suggestion that 'trophoblastic pseudotumour' is an unsuitable name for a potentially lethal disease.
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PMID:Placental site trophoblastic tumour (trophoblastic pseudotumour): a study of four cases requiring hysterectomy including one fatal case. 628 Nov 56

All deaths from hemorrhage (excluding disseminated intravascular coagulation) after legal abortion in the US were analyzed and compared with legal abortion deaths from all other causes during the January 1972 to December 31, 1979 period. The cause of death in each instance was determined after review of information from the woman, her family or friends, the medical staff; clinic or hospital records; autopsy reports; and death certificates. 24 women died from hemorrhage after legal abortion in the US from 1972-79. During this interval, 7,298,000 legal abortions were reported to the Centers for Disease Control (CDC). The death to case rate for hemorrhage from legal abortion during this period was 0.3 deaths/100,000 abortions. During this same interval, 132 women died of other causes related to legal abortion. No consistent temporal trend in deaths from hemorrhage after legal abortion was evident. The death to case rate for hemorrhage by year ranged from 0.1-0.5 deaths/100,000 abortions, reflecting the small numbers of such deaths each year. The proportion of all legal abortion deaths that was attributable to hemorrhage varied widely year by year, ranging from 4-36%. Women who died from hemorrhage after legal abortion were significantly older than women who died from other causes. Uterine perforation or rupture was far more frequent among women who died from hemorrhage than from other causes (71 versus 8%). Those who died from hemorrhage were 9.4 times more likely to have sustained trauma to the uterus than those who died from other causes. Few other important differences emerged between the 2 groups. Calculation of characteristic specific death to case rates revealed several factors associated with an increased risk of death from hemorrhage. Age was a powerful risk factor for fatal hemorrhage, the risk increasing with advancing age. Hemorrhage requiring transfusion was significantly more frequent among older women. Women of minority races had a higher risk of death from hemorrhage, although this was true for other causes of death as well. Gestational age also influenced the risk of death from hemorrhage. The risk increased progressively through the 16-20 week interval, after which it declined. Overall, the risk of death from hemorrhage was higher in hospitals. Preexisting medical condtions and incomplete abortion increased the risk of death from abortion. Women who sustained uterine perforation or rupture had a risk of death from hemorrhage over 1000 times that of women without this trauma. Uterine trauma caused the bleeding in 17 of the 24 fatal instances of hemorrhage. Lack of adequate postoperative monitoring or treatment of hemorrhagic shock was common to all 24 deaths.
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PMID:Fatal hemorrhage from legal abortion in the United States. 631 67

The importance of DIC in the management of gynecological malignancy, especially in advanced cases, was stressed on the basis of our experience with 8 cases. The overall incidence of DIC in our series of 366 cases of gynecological malignancies was 2.2%. However, DIC was experienced only in cases of advanced later stages and the recurrence of malignancy, and the incidence of DIC in these two groups were 2.2% and 7.2% respectively. In our 8 cases, DIC seemed to be provoked or worsened by antitumoric chemotherapy, major surgery, radiation therapy, infection, cerebral infarction and massive packed red cell transfusion. At the same time, an exceptional case of fulminating DIC which had probably been provoked by packed red cell transfusion in a patient with advanced but not detected endometrial cancer which developed in a endometriotic uterus was presented.
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PMID:Gynecological malignancies and disseminated intravascular coagulation. 653 11

A 27-year old woman admitted to the hospital after 5 days of vaginal bleeding at 12 weeks gestation had had a copper-T IUD inserted 10 months previously. The IUD string was no longer visible at pregnancy testing. Prior to admission she had experienced lower abdominal pain, increasingly heavy vaginal bleeding, fever, malaise, chills, and vomiting. Intravenous ampicillin and metronidazole were commenced and the uterus was evacuated under a general anesthetic. The copper-T was removed from the uterine cavity. A uterine swab at operation and preoperative blood cultures grew E. coli. A moderate degree of disseminated intravascular coagulation (DIC) was indicated by a coagulation profile. The case demonstrates that the copper-T may be associated with intrauterine sepsis and DIC. In the 1st trimester the risk of abortion following removal of a device is near 30%, while the rate of abortion for women in whom the string is no longer visible is near 48%. Patients presenting with pregnancy in the presence of an IUD and symptoms of sepsis should have the uterus evacuated under suitable antibiotic cover.
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PMID:Septic abortion in an IUCD user. 676 7

Two cases of chlamydial infection in pregnant women are described, the first serologically proved and the second suspected. In both cases the infection was probably contracted from sheep suffering with enzootic abortion. Both patients were farmers' wives who had helped their husbands and lambing and developed a non-specific febrile illness in late pregnancy. In the first case as there was no clinical improvement after 26 hours the patient was delivered by caesarean section of a live infant in good condition; the patient recovered fully. The second patient had presented a year earlier, the fetus had died in the uterus, and the patient himself died after spontaneous labour and forceps delivery 14 hours after admission. Both patients developed disseminated intravascular coagulation. As the casual agent in enzootic abortion in ewes has a predilection for the placenta, early delivery may be the management of choice in late pregnancy if infection with this organism if suspected.
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PMID:Pregnancy complicated by psittacosis acquired from sheep. 680 74

Rupture of the uterus is an uncommon obstetric emergency that usually occurs after 36 weeks gestation in a woman with a previous cesarean section. Complete rupture of the uterus with extrusion of the fetus into the peritoneal cavity is associated with high fetal mortality and with hypovolemic shock in the mother. Incomplete ruptures are less catastrophic and are often found incidentally at routine elective cesarean section. Management of uterine rupture consists of prompt recognition, rapid replacement of maternal blood volume, and early laparotomy and hysterectomy or, in selected cases, uterine repair. Disseminated intravascular coagulation has been reported in association with such obstetrical emergencies as abruptio placentae, intrauterine fetal demise, septic abortion, and amniotic fluid embolism. We report a case in which there was clinical and laboratory evidence of DIC in a patient with uterine rupture. The patient was successfully managed with prompt hysterectomy and replacement of coagulation factors.
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PMID:Rupture of the uterus with DIC. 682 98

A severe amniotic infection syndrome with a septic shock and a consumption coagulopathy is reported after an amniocentesis in second trimester. In literature, the risk of an amnionitis after amniocentesis amounts to 0.1%-0.4% and the risk of a severe maternal infection reaches 0.03%-0.19%. The available data show, that the clinical symptoms (rise in temperature, signs of septic shock) start 24-36 hours after the punction. The earlier treatment (evacuation of the uterus or - if necessary - hysterectomy) is accomplished, the more favourable will be the course of the disease with respect to septic shock and DIC. Determination of germs in each amniotic fluid seems to be of prognostic value; thus treatment can be started before infection becomes detrimental for the mother.
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PMID:[Amniotic infection syndrome after amniocentesis--a case report]. 692 37

In a patient with gestational trophoblastic disease midtrimester abortion was induced by intravenous application of prostaglandin F2 alpha. After evacuation of the uterus the patient developed a severe acute respiratory distress syndrome (ARDS). This syndrome has been described as resulting from trophoblastic emboli, hemorrhage shock, gestational osmotic imbalance or disseminated intravascular coagulation. Also an indirect side effect of prostaglandin has to be discussed. Patients who develop acute pulmonary complications after evacuation of a molar pregnancy appear to be at extremely high risk for persistent trophoblastic disease. The paper details the management and follow-up of this patient.
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PMID:[Gestational trophoblastic emboli as possible cause of an acute respiratory distress syndrome (author's transl)]. 731 29

Obstetrician-gynecologists at Assaf Harofeh Medical Center in Zerifin, Israel, performed 1064 midtrimester (14-22 weeks) pregnancy terminations between 1978 and 1993 by the laminaria and evacuation technique. Medical researchers wanted to determine whether the 70 (6.6%) patients with a previous Cesarean section faced an increased perioperative risk. None of the 70 women suffered any major complications (e.g., cervical lacerations). The mean operative time for women with a scarred uterus was not significantly different than that for those with an unscarred uterus (7.44 vs. 8 minutes). When the researchers examined only missed abortion cases, however, the mean operative time for women with a scarred uterus was significantly shorter than that for women with an unscarred uterus (4.8 vs. 6 minutes; p .005). Among missed abortion cases, more laminaria tents were needed in women with a scarred uterus than in those with an unscarred uterus (3.7 vs. 2.91; p .01), suggesting that the number of laminaria tents accounted for the difference in operative time. Among women with an unscarred uterus, 8 missed abortion cases had disseminated intravascular coagulation and 2 women experienced uterine atony with hemorrhage during the induced abortion. Except for those with disseminated intravascular coagulation, all the women were discharged from the hospital on the same day as the procedure. These findings show that laminaria and evacuation is a safe midtrimester pregnancy termination technique and that, since it requires only a few hours in an outpatient postoperative facility, it is also cost effective.
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PMID:Safety of midtrimester pregnancy termination by laminaria and evacuation in patients with previous cesarean section. 805 41


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