Disseminated intravascular coagulopathy in pregnancy: lessons from an international registry of the International Society for Thrombosis and Hemostasis: communication from the SSC of the ISTH

Abstract

Disseminated intravascular coagulopathy (DIC) in pregnancy is a severe maternal morbidity that is associated with short- and long-term complications. However, information regarding the causes of DIC treatments and outcomes in pregnancy is based on local reports. To address this gap, 2 Scientific and Standardization Committees, the Women’s Health Issues in Thrombosis and Hemostasis and Disseminated Intravascular Coagulation of the International Society on Thrombosis and Hemostasis, joined to establish an international global registry. This registry was developed to examine the current definitions, clinical presentations, and current practices around laboratory diagnosis and management of DIC worldwide. We collected data between 2018 and 2024; there were 148 data entries to the registry (13 countries); 104 of them included patients’ clinical and laboratory information. Placental abruption is the leading cause for ante- and intrapartum DIC, especially when associated with stillbirth. The leading etiology for postpartum DIC was uterine atony, especially following/during caesarean sections. The contribution of abnormally implanted placenta (ie, placenta accreta and/or previa) to the development of DIC is increasing. The leading pregnancy complications associated with DIC were placental abruption in HIC and preeclampsia in LMIC. Hemostatic parameters differed between women who had a positive pregnancy–specific DIC score and those who did not meet that criterion. Women with placental-mediated pregnancy complications had a lower median pregnancy–specific DIC score than those without such complications at the time of diagnosis of DIC and following recovery, suggesting a different mechanism of disease in the 2 groups.