Impact of fetal maceration grade on risk of maternal disseminated intravascular coagulation after intrauterine fetal death – A retrospective cohort study

Abstract

Disseminated intravascular coagulation (DIC) is a life-threatening event that is the endpoint of a pathologically activated cascade leading to excessive consumption of platelets culminating in bleeding. Several diseases are known to be associated with DIC, some of which may also occur during pregnancy or the puerperium. One of the potential risk factors that have been considered as a potential trigger for DIC is the retention of a highly macerated fetus after intrauterine fetal death (IUFD). However, sparse evidence exists on its clinical implication on hemostasis parameters. In this retrospective single-center study, we investigated the role of fetal maceration grades 0-III on the risk of DIC in 91 women following IUFD between gestational weeks (+days) 22 + 0 and 41 + 6 between 2003 and 2017. We calculated the Erez DIC-score after consideration of maternal platelet count (PC), prothrombin time (PT) and fibrinogen (Fib) and correlated the findings with fetal maceration grade. Mean (±SD) age of women was 32.1 ± 6.7 years. Neither maternal hemostasis parameters (PC, PT, Fib), nor the Erez score showed a statistically significant difference between maceration grades 0-III with median values of 1 for all four grades (maceration grade I: range 0 to 27; I: 0 to 51; II: 0 to 52; III: 0 to 39). We therefore conclude, that the pathophysiology of DIC in women after singleton IUFD is unrelated to the degree of fetal maceration.

Application of thromboelastography in diagnosing normal pregnancies and pregnancies with complications

“…In addition, the CI value of the AA group was low, which may be related to the patients receiving low‐dose aspirin or low‐molecular‐weight heparin in advance of undergoing TEG testing. Regarding stillbirths, Muin et al conducted a retrospective study on patients with in utero fetal death after a single birth and observed no significant difference in PC, PT, and other parameters, 25 which is consistent with our results. Unlike our non‐significant TEG results, Ikeuchi observed that patients with TA suffered abortion caused by decreased plasma plasminogen concentrations and increased C1 inactivator levels, and finally speculated that the decrease in urokinase inhibitory activity that leads to an increase in villous tissue fibrin activity is the potential reason for the miscarriage 26…”

Risk factors for postpartum haemorrhage in the Northern Province of Rwanda: A case control study

“…In case of stillbirth, PPH might be associated with retained placenta which was noted in a very high number of women (23%) in a retrospective chart review to evaluate stillbirth demographics, pregnancy and maternal risk factors, and complications of labour and birth [ 76 ]. Another attributable cause for this association was disseminated intravascular coagulation as reported by evidence [ 77 – 79 ] which definitely lead to massive blood loss. Though global data on causes of stillbirth is limited [ 80 ], evidence demonstrates that intrapartum complications, hypertension, diabetes, infection, placental impairment, and pregnancy lasting longer than forty weeks are potential causes of stillbirth [ 81 ]; and these causes have been identified to be risk factors for PPH [ 22 , 82 ].…”

Maceration determines diagnostic yield of fetal and neonatal whole body post‐mortem ultrasound

“…This timing is not possible to determine, unless induced through termination of pregnancy. During the maceration process, enzymatic autolysis of cells and tissues leads to fetal epidermal desquamation, skin reddening, and oedema of the internal organs . The severity and extent of these changes are graded by pathologists at external assessment of the body and believed to correlate with the length of the intrauterine retention of the fetus .…”

“…During the maceration process, enzymatic autolysis of cells and tissues leads to fetal epidermal desquamation, skin reddening, and oedema of the internal organs . The severity and extent of these changes are graded by pathologists at external assessment of the body and believed to correlate with the length of the intrauterine retention of the fetus . This rapid degradation process, occurring at maternal body temperature, is in contrast to the presumed slower tissue breakdown after fetal delivery prior to autopsy (ie, the postmortem interval), where the body is typically preserved in a refrigerated environment.…”