NCLEX Review Guide: Disseminated Intravascular Coagulation (DIC) in Pregnancy

Understanding DIC

• Disseminated Intravascular Coagulation (DIC) is a serious bleeding disorder where blood clots form throughout small blood vessels, consuming clotting factors and platelets, leading to both clotting and bleeding simultaneously.
• DIC is always secondary to an underlying condition and represents a medical emergency requiring immediate intervention.
• The process involves widespread activation of the coagulation cascade, resulting in consumption of clotting factors, fibrinogen, and platelets.

Common Obstetric Triggers

• Abruptio placentae is the most common obstetric cause, releasing tissue thromboplastin into maternal circulation.
• Severe preeclampsia/HELLP syndrome causes endothelial damage and microangiopathic hemolytic anemia.
• Amniotic fluid embolism introduces fetal tissue and amniotic fluid into maternal circulation, triggering massive coagulation.
• Fetal demise (retained dead fetus >5 weeks) releases thromboplastic substances from decomposing fetal tissue.
• Sepsis during pregnancy activates inflammatory cascades leading to widespread coagulation activation.

Signs and Symptoms

• Bleeding manifestations: Oozing from IV sites, gums, nose; petechiae, ecchymoses, and heavy vaginal bleeding.
• Thrombotic manifestations: Cyanosis of fingers/toes, decreased urine output, altered mental status from microvascular clots.
• Shock symptoms including hypotension, tachycardia, decreased perfusion, and altered level of consciousness.
• Organ dysfunction may present as acute kidney injury, respiratory distress, or neurological changes.

Laboratory Values

• Decreased values: Platelets (<100,000), fibrinogen (<150 mg/dL), antithrombin III, and factors V and VIII.
• Increased values: D-dimer (>500 ng/mL), fibrin degradation products (FDP), PT/PTT prolonged.
• Peripheral blood smear shows schistocytes (fragmented RBCs) indicating microangiopathic hemolytic anemia.
• Serial monitoring is essential as values change rapidly with disease progression or improvement.

Priority Interventions

1. Treat underlying cause immediately - delivery may be necessary for obstetric causes.
2. Establish large-bore IV access (18-gauge or larger) for rapid fluid and blood product administration.
3. Monitor vital signs continuously, including oxygen saturation and fetal heart rate if antepartum.
4. Assess for bleeding from all sites: IV sites, gums, nose, surgical incisions, and vaginal bleeding.
5. Prepare for blood product transfusion: packed RBCs, fresh frozen plasma, platelets, and cryoprecipitate.
6. Maintain strict intake and output monitoring to assess kidney function and fluid balance.

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