Case Scenarios of DIC Dr. Jyoti Bhaskar MD MRCOG Director Lifecare IVF Consultant Lifecare Centre and Pushpanjali Crosslay Hospital

Case 1 Mrs. S, 28 yrs old, G3 P2 Uneventful antenatal period, Admitted at 41 weeks for IOL 1mg PG gel inserted at 7 am, repeated at 4pm. Mild pains – subsided – reassesed and 1.5 mg PG tablet reinserted at 2am.

Pt developed good strong pain, progressed and delivered at 6 am. Placenta delivered complete, vaginal tears were being repaired. Profuse bleeding per vaginum, pt dyspnoeic Pulse 110 bpm, RR 30pm, BP 90/60

What would you do?? Call for Help Midwife Colleague – Junior, senior Anaesthesist Blood bank/ laboratory Haematologist GDA - Porter

Pt shifted immediately to theatre Oxygen by mask till anaesthetist came 2 14/16 G cannulae inserted. Sample taken for crossmatch, Haemogram,Coagulation studies, Baseline KFT, LFT Immediate request for 4 units of PRBC, 2 FFP, 1 Platelet

Pt was intubated as in respiratory distress. All uterotonics tried. Cervix, vagina explored. No let up in bleeding despite all resuscitative/ restorative measures. Decision for hysterectomy – 2 consultants involved

Administration involved. Relatives counselled Hysterectomy done. Abdominal packing done with drains Shifted to ICU Blood component replacement continued

Patient reclosed after 48 hrs when stable. Total of 35 units of blood, 10 units of FFP and 2 units of platelet given Patient survived.

Case 2 Mrs K, 26 yrs, G1, 37 wks uneventful pregnancy. Met with car accident – wheel hit on the uterus. Drove to hosp for a check up Admitted for observation. Stable, no BPV, no signs of APH.

30 mts later, NST suspicious Decision for LSCS Coag profile normal, blood crossmatched On LSCS Liquor clear, No blood in abdomen Small RPC seen. Surgeon called to examine the rest of abdomen

Abdomen closed Clear urine Shifted to recovery 20 mts later, frank haematuria and bruises all over

Same steps as before PT,Aptt deranged, FDP high, Same protocol No increase in BPV seen Increased abdominal distension. On USG – excessive fluid collection in abdomen seen. Paracentesis done

Initially pt not intubated, but after 8 hrs needed ventilation. Blood component replacement continued. Did not need any other surgery Pt went into ATN – needed dialysis Recovered completely and 2 years had a normal delivery.