This case involves a twenty-five-year-old female patient who presented to a local hospital for an induced elective abortion. At the time of the procedure, the patient was approximately fifteen weeks pregnant and, according to the medical note, it was conducted without incident. The patient was discharged home and the next morning the patient woke up covered in blood. She was rushed back to the hospital and an emergency D&C was performed due to a suspected incomplete abortion. The patient continued to bleed at which point the procedure was converted to an open hysterectomy to remove an uncontrolled hemorrhaging uterus. Though the doctors had originally worried that she was suffering from an amniotic fluid embolism, the patient was eventually treated for disseminated intravascular coagulopathy and it took a thirty-day hospital stay in the ICU to correct her bleeding disorder.
Question(s) For Expert Witness
1. What causes disseminated intravascular coagulopathy (DIC) and how should it have been managed to prevent such an extended hospital stay?
Expert Witness Response E-001236
Treatment should primarily focus on addressing the underlying disorder. DIC can result from several clinical conditions, including sepsis, trauma, obstetric emergencies, and malignancy. Surgical management is limited to primary treatment of certain underlying disorders, which in this case would be the hysterectomy to correct the cause of bleeding. Platelet and factor replacement should be directed at correcting laboratory abnormalities and addressing clinically relevant bleeding or meeting procedural needs. Heparin should be provided to those patients who demonstrate extensive fibrin deposition without evidence of substantial hemorrhage, and it is usually reserved for cases of chronic DIC. Heparin is appropriate to treat the thrombosis associated with DIC. It also has a limited use in acute hemorrhagic DIC in a patient with a self-limited condition of acral cyanosis and digital ischemia.
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