DISSEMINATED INTRAVASCULAR COAGULATION (DIC)

 Acquired disorder of blood clotting in which the fibrinogen level falls to below effective limits

 An emergency because it can result in extreme blood loss.

 Platelets - form a seal to prevent further loss of blood

 Intrinsic and extrinsic clotting pathways with fibrin threads --- to produce a firm, fixed structure.

 Thrombin activates fibrinolysin ---- a proteolytic enzyme, begins digestion of excess fibrin
threads (anticoagulation).

 Occurs when there is such extreme bleeding and so many platelets and fibrin

 Prothrombin - low because it depends on the conversion of fibrinogen to fibrin

 Tthrombin time – elevated, measures the time necessary for conversion of fibrinogen to fibrin

 Fibrinogen - decreased to <150 mg/dl because fibrinogen is not available

 Fibrin split products - >40 mcg/ml reflecting the destruction of fibrinogen or fibrin)

 D-dimer analysis - specific for fibrin (not fibrinogen) ------- abnormal in 90% patient w/ DIC

EARLY SYMPTOMS ----------- Bruising or bleeding from an intravenous site.

 Associated: premature separation of the placenta, hypertension of pregnancy, amniotic fluid

embolism, placental retention, septic abortion, and retention of a dead fetus.

HOW TO STOP DIC

 Underlying insult that began the phenomenon must be halted.

 Marked coagulation must be stopped so that coagulation factors can be freed and normal

- Heparin - first intravenously, then by subcutaneous (SQ) injection

- Postpartum hemorrhage - could occur from poor clotting after delivery of the placenta.

 Blood or platelet transfusion --- necessary to replace blood or platelet loss

 Whole blood for transfusion - Antithrombin III factor, fibrinogen, or cryoprecipitate

 Fresh frozen plasma or platelets --- can also aid in restoring clotting function.

 action of heparin— to discourage blood coagulation— wrong medication

EVALUATION

 Focuses on determining whether a woman’s blood coagulation studies are returning to normal

 Fetal and newborn assessment - important to evaluate the efficiency of the placental
circulation.
 INTRAUTERINE TRANSFUSION (IUT)

 To restore fetal red blood cells ---- by injecting RBCs by amniocentesis technique directly

 Amniocentesis technique -- procedure used to take out a small sample of the amniotic fluid for

 Amniotic fluid - a clear, pale yellow fluid that protects the fetus from injury and infection.

 A procedure in which red blood cells (RBCs) from a donor are injected into the fetus

 Before 20th week gestation ------------- given to prevent hydrops fetalis and fetal death

 Intrauterine = situated, used, or occurring within the uterus

 Transfusion = to transfer fluid, such as blood, into a vein or an artery

 Anemia -- a condition which amount of RBCs and hemoglobin falls below its normal level.

 After deposition -- cannula is withdrawn and the woman is urged to rest for approx. 30mins

 Cord blood vessel ---- could be lacerated by the needle or the uterus could be so irritated

 90% ---- of fetuses that do not have hydrops survive

 75% ----- of fetuses that have hydrops survive

 RhIG injection (Mother) ---- help reduce increased sensitization from any blood that exchanged

 Phototherapy lights ----- to reduce the level of bilirubin released from destroyed RBCs.

 FETAL ANEMIA MAY BE CAUSED (3)

1. Viral infections in the mother

 Parvovirus B19 --- due to a combination of hemolysis of the red blood cells

 Erythema infectiosum -- fifth disease ------------- AIDS -- cause of chronic anemia.

2. Twin-to-twin transfusion syndrome

 Not evenly dispensed and there is an imbalance in the blood exchange between the twins.

3. Rh incompatibility

 Mother is Rh-negative and Baby is Rh-positive

 Rh antibodies --- help drive an immune system attack against the baby

BLOOD MUST BE:

 Less than 5 days old ---------- Low risk of Cytomegalovirus (CMV negative)
 Hematocrit 80% or higher --------- O negative and compatible with mother --------- Irradiated
 Lack antigens which antibodies are directed ----- 75-175ml determined by fetal size and age

RISKS

 Uterine infection ------- Fetal infection -------- Preterm labour ---------- Fetal death
 Excessive bleeding and mixing of fetal and maternal blood ------Amniotic fluid leakage