1. Disseminated intravascular coagulation (DIC)

2. pathogenesis Extensive vessels and tissues damage ?
Release of thromboplasetins
Utilization of fibrinogen and other clotting factors in an aimless coagulation process .
Fibrin
Stimulate fibrinolitic system
Breaks fibrin and fibrinogen Into FDP which have an anticoagulant effect
Aggravates hemorrhage and shock
Ischemia more tissue damage
Vicious circle.

3. Clinical manifestations
The Hypercoagulability of DIC manifest as the occlusion of vessels in microcirculation and resulting organ failure.
Thrombosis of large vessels and cerebral embolism also occurs .
Hemodynamic complications and shock are common among patients with acute DIC.

4. Bleeding from at 3 unrelated sites is particularly suggestive of DIC
Brain: altered state of consciousness , seizures.
Lung :respiratory distress.
Heart: hypotension ,cardiac arrest.
Kidney :Oliguria, anuria ,acidosis.

5. Anticoagulant effect of FDP
Inhibition of platelet function .
Interference with myometrial contraction .

6. Predisposing factors Placenta accreta . Rupture uterus .
Abruptio placenta .
Amniotic fluid embolism.
Endotoxic shock .
Eclampsia and pre-eclampsia.
Hydatidiform mole.
IUFD and missed abortion.
Intra amniotic hypertonic saline for induction abortion.
Massive transfusion and incompatible blood .
Dextran infusion
Trauma particularly to the brain ..
Prolonged shock of whatever cause.
Placenta accreta .
Rupture uterus .

7. Clinical feature Oozing of blood . Bruising . Epistaxis Hematuria .
Hematoma formation especially at wound and venepuncture site .
Postpartum hemorrhage .

8. Investigations Clot observation test .
5-10 cc blood in a test tube will be clotted in 10 minutes .in DIC no clot will be formed .
Fibrindex test :
0.5 CC fibindex +0.5CC plasma in a test tube ,normally normally clot will be formed within 5-10 seconds .

9. Laboratory tests Fibrinogen level drops. FDP increased.
Platelet count decreased .
Presence of schistocytes in blood smear.
D-dimer test is more specific of detection of fibrin.

10. Management Elimination of the underlying cause .
Fresh blood transfusion .contain F II ,V ,VIII.
Platelet concentrate at a dose of 1-2 U/10 kg body weight.
FFP: contain 3 gr fibrinogen /L and F V and VIII.
Fibrinogen 4-6 gr IV .
Heparin :
Antifibrinolytic agents :EACA, trasylol or tranexamic acid . V,