Acute obstetric coagulopathy without severe postpartum haemorrhage following medical termination of pregnancy presenting as gingival bleeding: a case report

Abstract

Postpartum haemorrhage is a leading cause of maternal morbidity and mortality worldwide – rarely this is complicated by coagulopathy. Our understanding of the mechanisms of acute obstetric coagulopathy remains uncertain. This report aims to highlight the importance of its early recognition, diagnosis and management.

We report a case of acute obstetric coagulopathy potentially exacerbating postpartum haemorrhage following medical termination of pregnancy at 23 weeks gestation. We describe an unusual clinical presentation with gingival bleeding and evidence of hyperfibrinolysis beyond that of previously described cases. Despite the extreme coagulation abnormalities, the clinical situation did not proceed to severe postpartum haemorrhage owing to early suspicion and recognition of acute obstetric coagulopathy, as well as targeted treatment with fibrinogen concentrate and antifibrinolytics. The patient developed mild acute kidney injury which recovered spontaneously prior to discharge.

This case highlights the need for better understanding of acute obstetric coagulation and its underlying mechanisms. This specific coagulation disorder has been described relatively recently for the first time and has never been reported in patients undergoing a medical termination of pregnancy in the second trimester. Further research is needed to improve our understanding on its mechanisms and triggers to potentially inform optimal management.