Virginia Research Day 2025

Medical Resident Research Case Reports

23 Fulminant Disseminated Intravascular Coagulation Due to Placental Abruption Following Intrauterine Fetal Demise

Meridith King, DO; Fatima Guzman-Gawel, MD Corresponding author: meridith.hawkins@LPNT.net

Sovah Health Family Medicine Residency, Danville, VA

be 1cm/50%/-3. No fetal heart tones were detected on FHT or bedside US. Patient was admitted for induction of labor due to intrauterine fetal demise. Labor consent was signed and started on Cytotec for labor augmentation. Lab work was remarkable for WBC 19.22, Hgb 8.3, platelets 81,000, and creatinine 2.52. Repeat BP readings were noted to be elevated. Urine protein/Cr ratio and LDH were ordered and found to be significantly elevated at 5.03 mg/dl and 321 IU/L consistent with pre-eclampsia with severe features. Patient progressed to 3 cm/80%/0 on repeat cervical exam. 2 hours after induction, patient experienced sudden onset of severe vaginal bleeding. Stat TXA x 2 doses and Terbutaline were given to control bleeding and stop contractions. Hgb and platelets dropped to 5.5 and 44,000. PT and fibrinogen were 16.5 and 38. She was given a total of 6 units of pRBC, 6 units of FFP, 1 unit of platelets, and 2 units of cryoprecipitate. Patient was diagnosed with fulminant DIC and transferred to Carilion for higher

level of OB care. Patient was in active labor upon arrival to Carilion and delivered within 10 minutes. Nearly complete placenta abruption was noted with estimated 2,000 cc blood loss at time of delivery. She received additional 2 units of pRBC, IM Pitocin, Methergine, and rectal Cytotec for post-uterine tone, IV Unasyn for suspected chorioamnionitis, and IV Magnesium to treat Pre-eclampsia with severe features. Patient was subsequently transferred to ICU for close monitoring. Discussion: Diagnosis and management of DIC can be very challenging. Multi-organ failure or death can occur if early recognition and treatment are delayed. Treatment focuses on addressing the underlying cause and is best managed with interdisciplinary collaboration to ensure accurate diagnosis, management, and ongoing monitoring to enhance quality of care and outcomes for patients with DIC.

Background: Disseminated Intravascular Coagulation (DIC) is a rare but serious hypercoagulable blood disorder that consumes clotting factors and platelets ultimately leading to hemorrhage and multiple organ dysfunction. Common symptoms include dyspnea, fever, bruising, severe bleeding, and confusion. Condition typically presents as an acute complication from severe sepsis, malignancy, trauma, or obstetric emergency such as placental abruption. If not treated promptly, can be life-threatening. Case Presentation: Patient is a 23-year-old African American G2 P0010 female at 36.0 wga with PMH of limited prenatal care, marijuana use, positive Chlamydia and Trichomonas s/p treatment, and other chronic conditions who presented for pelvic pressure and decreased fetal movement. Vitals were BP 130/73, HR 120, respirations 30, and O2 saturation 100% on RA. Cervical exam was performed. Several small blood clots were evacuated and determined to

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