Postpartum Disseminated Intravascular Coagulation: A Comprehensive Review of Pathophysiology, Diagnosis, Management, and Prevention.

Abstract

Disseminated intravascular coagulation (DIC) in the postpartum period is a rare but potentially life-threatening complication arising from various obstetric conditions, including postpartum hemorrhage (PPH), placental abruption, intrauterine fetal demise (IUFD), and amniotic fluid embolism. This review explores pathophysiology, risk factors, diagnostic challenges, and management strategies of postpartum DIC. The delicate balance of hemostasis during pregnancy predisposes women to thromboembolic events, which, when disrupted, may lead to rapid consumption of coagulation factors and subsequent coagulopathy. The incidence of obstetric-related DIC varies globally, with higher rates reported in low-resource settings due to delayed diagnosis and management. Diagnostic criteria, including the International Society on Thrombosis and Haemostasis (ISTH), Japanese obstetric DIC, and pregnancy-specific DIC scores, are evaluated, emphasizing their applicability and limitations in obstetric practice. Preventive strategies, primarily targeting the early identification and treatment of PPH, are discussed, with particular focus on active management of the third stage of labor, the administration of uterotonic agents, and the use of antifibrinolytic medications like tranexamic acid. Timely recognition, standardized diagnostic protocols, and multidisciplinary management are essential for improving maternal outcomes and reducing the burden of postpartum DIC.