1. Predisposing factors of DIC:

1. Abruptio placentae.
2. Septic abortion.
3. Amniotic fluid embolism.
4. IUFD.
5. Rupture uterus.

2. DVT & Pulmonary embolism:

• Increase maternal death.
• Increase incidence during pregnancy due to:
  • Hypercoagulability state of the blood & increase fibrinogen level especially in late pregnancy.
  • Increase platelets number & adhesiveness.
  • Stasis of blood.

2.1. DVT:

• Usually occur in 2^nd wk after delivery classically day 10-12.
• Occur in deep veins of pelvis (ilio-femoral group).
• Phlegmasia alba dolens:
  • Known as milk leg or white leg.
  • Is part of a spectrum of diseases related to deep vein thrombosis.
  • Commonly seen during pregnancy and in mothers who have just given birth.
  • It resulting from a compression of the left common iliac vein against the pelvic rim by the enlarged uterus.
  • Leg swollen, tender, painful, white & cold.
• Diagnosis of DVT confirmed by Doppler U/S.
• Management:
  • Early mobilization of pt. after surgery.
  • Reduce pressure on calf region during surgery.
  • Use of prophylactic anticoagulants especially in high risk pt.:
    • Obese.
    • High parity.
    • Pt. undergoing major surgery.
    • Elderly.
    • Pt. using OCP.
    • Pt. with previous thrombo-embolic complications.
  • Mini HEP (small dose of heparin) 5000unit IV pd for 5days. If the pt. undergoing surgery & she is in a high risk give  the dose subcutaneously  after 2^nd day of surgery.
  • Uni HEP (long acting heparin) 1tab. daily for 5 days. In case of surgery or delivery give it from 2^nd day.
• Treatment of Phlegmasia alba dolens:
  • The leg putted in cage at rest to reduce pressure on calf region.
  • Give analgesia.
  • Anticoagulants (heparin 10,000 IU in normal saline 6hourly for 72hrs in combination with warfarin 20-30mg orally (need 36hrs to act).
  • Monitoring of prothrombin & INR (around 2 in pt with warfarin).
  • Give the pt. aspirin.
• Heparin doesn't cross the placenta.
• Warfarin is contraindicated in pregnancy it may cause achondroplasia & optic nerve atrophy.
• Protamine sulfate is usually administered to reverse the large dose of heparin.
• Fresh blood vitamin K is antidote for warfarin overdose.

2.2. Pulmonary embolism:

• Is a blockage of the pulmonary artery or one of its branches, usually occurring when a deep vein thrombus becomes dislodged from its site of formation and travels, or embolizes, to the arterial blood supply of one of the lungs.
• Common symptoms include difficulty breathing, chest pain on inspiration, cough, restlessness and palpitations.
• Treatment is typically with anticoagulant medication, including heparin and warfarin.
• Severe cases may require thrombolysis with drugs such as tissue plasminogen activator (tPA) eg. Streptokinase.