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Diagnosis and Treatment of Obstetrics Disseminated Intravascular Coagulation in Resource Limited Settings

1College of Medicine, University of Nigeria Ituku-Ozalla Campus, Haematology and Immunology, Enugu, Nigeria, 2College of Medicine, University of Nigeria Ituku-Ozalla Campus, Obstetrics and Gynaecology, Enugu, Nigeria, 3Chukwuemeka Odumegwu Ojukwu University, Obstetrics and Gynaecology, Awka, Nigeria, 4Federal Medical Centre, Obstetrics and Gynaecology, Owerri, Nigeria, 5Lagos University Teaching Hospital, Obstetrics and Gynaecology, Lagos, Nigeria

Abstract Number: PB0362

Meeting: ISTH 2020 Congress

Theme: Coagulation and Natural Anticoagulants » Hemostasis and Organ Dysfunction

Background: Disseminated intravascular coagulation (DIC) is one of the commonest causes of abnormal bleeding during pregnancy and puerperium. It’s successful management requires early recognition, specific but vigorous treatment, a challenging feat in resource limited settings (RLS).

Aims: To determine Obstetricians’ approach in diagnosing and treating obstetrics DIC in a RLS.

Methods: A semi-structured pre-tested 4-sectioned questionnairre was used to collect demographic data of Nigerian Obstetricians and data on their practice in the diagnosis and treatment of obstetrics DIC.

Results: A total of 171 Obstetricians responded with a majority of them (67.2%) having 5-15 years of specialist practice. Within the year under review, most of the respondents saw < 10 cases of DIC each. Preeclampsia was the most frequent cause identified (70.2%) followed by postpartum haemorrahge (58.3%). Platelet count determination was the test mostly used (95.9%) to make a diagnosis of DIC whereas, antithrombin assay was the least (20.6%) requested investigation. While about two-third would monitor the evolution of DIC, a little less than half of the Obstetricians would not repeat laboratory testing more than every 2 days, reason mainly (61.8%) due to patient's financial constraint. Likewise, majority will not look out for non-overt DIC. Majority would treat for low haemoglobin concentration and platelet count and a platelet transfusion trigger of 20-50 x109/L was used by 73.2% of the respondents. Almost three-quarter of them preferred fresh whole blood as the first line of treatment of DIC.
There was a non-significant association between years of practice and use of DIC score and index of suspicion for non-overt DIC, However, there was a significant association between years of practice and serial monitoring of evolution of DIC (X2 10.8 p value 0.02).

Conclusions: DIC remains a challenge in the obstetrics practice in RLS especially in investigations, monitoring and index of suspicion for non-overt DIC.

To cite this abstract in AMA style:

Okoye H, Nwagha T, Ugwu E, Menuba I, Duru A, Ugwu A, Ezebialu I, Eze S, Ugwu A. Diagnosis and Treatment of Obstetrics Disseminated Intravascular Coagulation in Resource Limited Settings [abstract]. Res Pract Thromb Haemost. 2020; 4 (Suppl 1). https://abstracts.isth.org/abstract/diagnosis-and-treatment-of-obstetrics-disseminated-intravascular-coagulation-in-resource-limited-settings/. Accessed January 21, 2022.

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