DIC score in pregnant women–a population based modification of the International Society on Thrombosis and Hemostasis score

“The fourth component of the ISTH overt DIC score is the concentrations of D-dimer or fibrin split products [28].”

“However, thrombocytopenia is a hallmark of severe pregnancy complications such as preeclampsia and hemolysis, elevated liver enzymes and low platelets (HELLP) syndrome [41,49,50,71–76].”

“5 mg/L is considered as the upper limit of the normal value in non-pregnant patients [80–82].”

“Moreover, it was also associated with a good survival prediction of non-pregnant patients hospitalized in intensive care units [52,83,84].”

“In addition, systemic changes are observed in the maternal plasma including : 1) increased concentrations of clotting factors VII, VIII, IX, X and XII [3,9–13] and fibrinogen; 2) a reduction in the concentration of anticoagulant proteins such as protein S and tissue factor pathway inhibitor (TFPI)-1 [14–18]; 3) acquir…”

“In addition, systemic changes are observed in the maternal plasma including : 1) increased concentrations of clotting factors VII, VIII, IX, X and XII [3,9–13] and fibrinogen; 2) a reduction in the concentration of anticoagulant proteins such as protein S and tissue factor pathway inhibitor (TFPI)-1 [14–18]; 3) acquir…”

“Pregnancy is a unique state in which the platelet count slightly decreases with advancing gestation [68–70], and about 7% of all pregnant women will suffer from thrombocytopenia [70]; moreover, it has been proposed that pregnancy is a compensated state of platelet consumption [69].”

“Thus, in the non-pregnant state a DIC score is important in the diagnosis of patients with DIC and carries a diagnostic and prognostic value [53–58].”

“In addition, systemic changes are observed in the maternal plasma including : 1) increased concentrations of clotting factors VII, VIII, IX, X and XII [3,9–13] and fibrinogen; 2) a reduction in the concentration of anticoagulant proteins such as protein S and tissue factor pathway inhibitor (TFPI)-1 [14–18]; 3) acquir…”

“However, thrombocytopenia is a hallmark of severe pregnancy complications such as preeclampsia and hemolysis, elevated liver enzymes and low platelets (HELLP) syndrome [41,49,50,71–76].”

“In light of the above three DIC scores were previously developed [28,51,52].”

“DIC is a serious and life threatening complication that can result from several mechanisms, including acute and chronic consumptive coagulopathy, endothelial dysfunction and platelets activation, and acute liver dysfunction [28,30–41].”

“During pregnancy, the concentrations of D-dimer or fibrin split products changes extensively, and it has been proposed that they have no diagnostic value during gestation [25,63,64].”

“DIC is a serious and life threatening complication that can result from several mechanisms, including acute and chronic consumptive coagulopathy, endothelial dysfunction and platelets activation, and acute liver dysfunction [28,30–41].”

“In addition, systemic changes are observed in the maternal plasma including : 1) increased concentrations of clotting factors VII, VIII, IX, X and XII [3,9–13] and fibrinogen; 2) a reduction in the concentration of anticoagulant proteins such as protein S and tissue factor pathway inhibitor (TFPI)-1 [14–18]; 3) acquir…”

“Thus, in the non-pregnant state a DIC score is important in the diagnosis of patients with DIC and carries a diagnostic and prognostic value [53–58].”

“The most prominent obstetrical pathologies associated with the development of DIC are post-partum hemorrhage, placental abruption, HELLP syndrome, preeclampsia, retained dead fetus, acute fatty liver, and septic abortion [42–50].”

“Moreover, about 50% of patients with DIC will have a platelet count lower than 50610(6)/L [66,67].”

“However, thrombocytopenia is a hallmark of severe pregnancy complications such as preeclampsia and hemolysis, elevated liver enzymes and low platelets (HELLP) syndrome [41,49,50,71–76].”

“5 mg/L is considered as the upper limit of the normal value in non-pregnant patients [80–82].”

“These parameters are also increased in thromboembolic diseases, recent surgery, and inflammatory condition; thus, they can poorly differentiate these patients from those with DIC [78].”

“In addition, systemic changes are observed in the maternal plasma including : 1) increased concentrations of clotting factors VII, VIII, IX, X and XII [3,9–13] and fibrinogen; 2) a reduction in the concentration of anticoagulant proteins such as protein S and tissue factor pathway inhibitor (TFPI)-1 [14–18]; 3) acquir…”

“Indeed, Chakraverty et al [77] reported that among 235 patients admitted to an adult intensive care unit, clinical coagulopathy, defined as bleeding unexplained by local or surgical factors, was identified in 13.6% of patients; moreover, a prothrombin time (PT) difference . or = 1.5 was found in 66% of patients and a…”

“Thus, in the non-pregnant state a DIC score is important in the diagnosis of patients with DIC and carries a diagnostic and prognostic value [53–58].”

“Moreover, it was also associated with a good survival prediction of non-pregnant patients hospitalized in intensive care units [52,83,84].”

“During pregnancy, the concentrations of D-dimer or fibrin split products changes extensively, and it has been proposed that they have no diagnostic value during gestation [25,63,64].”

“Indeed, fibrinogen increases during gestation especially through the third trimester and declines only two days after delivery [59–64].”

“DIC is a serious and life threatening complication that can result from several mechanisms, including acute and chronic consumptive coagulopathy, endothelial dysfunction and platelets activation, and acute liver dysfunction [28,30–41].”

“DIC is a serious and life threatening complication that can result from several mechanisms, including acute and chronic consumptive coagulopathy, endothelial dysfunction and platelets activation, and acute liver dysfunction [28,30–41].”

“Pregnancy is a unique state in which the platelet count slightly decreases with advancing gestation [68–70], and about 7% of all pregnant women will suffer from thrombocytopenia [70]; moreover, it has been proposed that pregnancy is a compensated state of platelet consumption [69].”

“In addition, systemic changes are observed in the maternal plasma including : 1) increased concentrations of clotting factors VII, VIII, IX, X and XII [3,9–13] and fibrinogen; 2) a reduction in the concentration of anticoagulant proteins such as protein S and tissue factor pathway inhibitor (TFPI)-1 [14–18]; 3) acquir…”

“Sufficient local hemostasis is achieved by the abundance of tissue factor in the decidua [4,5], chorionic membranes and amniotic fluid [6–8].”

“Sufficient local hemostasis is achieved by the abundance of tissue factor in the decidua [4,5], chorionic membranes and amniotic fluid [6–8].”

“Nevertheless, severe peri-partum bleeding is still a leading cause for maternal morbidity and mortality even in these countries [26,27].”

“Thus, in the non-pregnant state a DIC score is important in the diagnosis of patients with DIC and carries a diagnostic and prognostic value [53–58].”

“In addition, systemic changes are observed in the maternal plasma including : 1) increased concentrations of clotting factors VII, VIII, IX, X and XII [3,9–13] and fibrinogen; 2) a reduction in the concentration of anticoagulant proteins such as protein S and tissue factor pathway inhibitor (TFPI)-1 [14–18]; 3) acquir…”

“DIC is a serious and life threatening complication that can result from several mechanisms, including acute and chronic consumptive coagulopathy, endothelial dysfunction and platelets activation, and acute liver dysfunction [28,30–41].”

“DIC is a serious and life threatening complication that can result from several mechanisms, including acute and chronic consumptive coagulopathy, endothelial dysfunction and platelets activation, and acute liver dysfunction [28,30–41].”

“The most prominent obstetrical pathologies associated with the development of DIC are post-partum hemorrhage, placental abruption, HELLP syndrome, preeclampsia, retained dead fetus, acute fatty liver, and septic abortion [42–50].”

“Thus, in the non-pregnant state a DIC score is important in the diagnosis of patients with DIC and carries a diagnostic and prognostic value [53–58].”

“However, thrombocytopenia is a hallmark of severe pregnancy complications such as preeclampsia and hemolysis, elevated liver enzymes and low platelets (HELLP) syndrome [41,49,50,71–76].”

“Indeed, fibrinogen increases during gestation especially through the third trimester and declines only two days after delivery [59–64].”

“The most prominent obstetrical pathologies associated with the development of DIC are post-partum hemorrhage, placental abruption, HELLP syndrome, preeclampsia, retained dead fetus, acute fatty liver, and septic abortion [42–50].”

“Moreover, it was also associated with a good survival prediction of non-pregnant patients hospitalized in intensive care units [52,83,84].”

“In addition, systemic changes are observed in the maternal plasma including : 1) increased concentrations of clotting factors VII, VIII, IX, X and XII [3,9–13] and fibrinogen; 2) a reduction in the concentration of anticoagulant proteins such as protein S and tissue factor pathway inhibitor (TFPI)-1 [14–18]; 3) acquir…”

“However, thrombocytopenia is a hallmark of severe pregnancy complications such as preeclampsia and hemolysis, elevated liver enzymes and low platelets (HELLP) syndrome [41,49,50,71–76].”

“The most prominent obstetrical pathologies associated with the development of DIC are post-partum hemorrhage, placental abruption, HELLP syndrome, preeclampsia, retained dead fetus, acute fatty liver, and septic abortion [42–50].”

“Thus, in the non-pregnant state a DIC score is important in the diagnosis of patients with DIC and carries a diagnostic and prognostic value [53–58].”

“The latter is a leading cause for DIC during pregnancy [47,49,50]; and the severity of HELLP syndrome was defined by some according to the degree of the thrombocytopenia [41,49,50,71–76], and women with HELLP syndrome who had a platelet count of ,50610(9)/L were at increased risk for DIC and liver hematoma/rupture [49…”

“Sufficient local hemostasis is achieved by the abundance of tissue factor in the decidua [4,5], chorionic membranes and amniotic fluid [6–8].”

“In addition, systemic changes are observed in the maternal plasma including : 1) increased concentrations of clotting factors VII, VIII, IX, X and XII [3,9–13] and fibrinogen; 2) a reduction in the concentration of anticoagulant proteins such as protein S and tissue factor pathway inhibitor (TFPI)-1 [14–18]; 3) acquir…”

“In addition, systemic changes are observed in the maternal plasma including : 1) increased concentrations of clotting factors VII, VIII, IX, X and XII [3,9–13] and fibrinogen; 2) a reduction in the concentration of anticoagulant proteins such as protein S and tissue factor pathway inhibitor (TFPI)-1 [14–18]; 3) acquir…”

“In addition, systemic changes are observed in the maternal plasma including : 1) increased concentrations of clotting factors VII, VIII, IX, X and XII [3,9–13] and fibrinogen; 2) a reduction in the concentration of anticoagulant proteins such as protein S and tissue factor pathway inhibitor (TFPI)-1 [14–18]; 3) acquir…”

“The latter is a leading cause for DIC during pregnancy [47,49,50]; and the severity of HELLP syndrome was defined by some according to the degree of the thrombocytopenia [41,49,50,71–76], and women with HELLP syndrome who had a platelet count of ,50610(9)/L were at increased risk for DIC and liver hematoma/rupture [49…”

“In addition, systemic changes are observed in the maternal plasma including : 1) increased concentrations of clotting factors VII, VIII, IX, X and XII [3,9–13] and fibrinogen; 2) a reduction in the concentration of anticoagulant proteins such as protein S and tissue factor pathway inhibitor (TFPI)-1 [14–18]; 3) acquir…”

“An animal model suggests that the concentrations of fibrinogen are influenced by changes in estrogen concentrations which increase as labor approaches [65].”

“In addition, systemic changes are observed in the maternal plasma including : 1) increased concentrations of clotting factors VII, VIII, IX, X and XII [3,9–13] and fibrinogen; 2) a reduction in the concentration of anticoagulant proteins such as protein S and tissue factor pathway inhibitor (TFPI)-1 [14–18]; 3) acquir…”

“Sufficient local hemostasis is achieved by the abundance of tissue factor in the decidua [4,5], chorionic membranes and amniotic fluid [6–8].”

“We agree with the approach presented by Terao and his colleagues [29] regarding the need for a predisposing event that puts the mother at risk for DIC as an essential condition for calculating the DIC score.”

“In addition, systemic changes are observed in the maternal plasma including : 1) increased concentrations of clotting factors VII, VIII, IX, X and XII [3,9–13] and fibrinogen; 2) a reduction in the concentration of anticoagulant proteins such as protein S and tissue factor pathway inhibitor (TFPI)-1 [14–18]; 3) acquir…”

“In addition, systemic changes are observed in the maternal plasma including : 1) increased concentrations of clotting factors VII, VIII, IX, X and XII [3,9–13] and fibrinogen; 2) a reduction in the concentration of anticoagulant proteins such as protein S and tissue factor pathway inhibitor (TFPI)-1 [14–18]; 3) acquir…”

“The process of labor and delivery is associated with an increased risk for severe maternal hemorrhage [1].”

“Moreover, Hatada et al [79] studied the cutoff values of fibrin related markers Figure 3.”

“The most prominent obstetrical pathologies associated with the development of DIC are post-partum hemorrhage, placental abruption, HELLP syndrome, preeclampsia, retained dead fetus, acute fatty liver, and septic abortion [42–50].”

“scoring system has shown a sensitivity of 88% and a specificity of 96% for the diagnosis of DIC in pregnancy [4].”