The college has  show some interest in this condition, but usually it appears as the answer to a data interpretation question ("What's wrong with these coags?"). Examples include Question 13.1 from the second paper of 2013, Question 29.1 from the second paper of 2012 and Question 6.1 from the second paper of 2008. Apart from these, DIC comes up frequently in the past papers as an important complication to mention (eg. in the discussion of amniotic fluid embolism,  etc etc).

Causes of DIC

The causes of DIC are numerous,

 

Causes of peripartum DIC

In the context of pregnancy and PPH one can narrow down one's list of possibile aetiologies.

Still, there is quite a large number of potential peripartum causes for DIC:

 

  • Abruptio placentae
  • Placenta accreta
  • Amniotic fluid embolism
  • Retained dead fetus
  • Abortion induced with hypertonic fluids (saline or urea)
  • Intrauterine sepsis
  • Incompatible blood transfusion
     

An excellent review article lists these, and others, and delves deep into their pathophysiology and management.

 

D-Dimer studies in the diagnosis of DIC

Fibrin degradation products seem to be a valuable adjunct for the laboratory diagnosis of DIC.

In essence, a D-dimer is a small protein breakdown product, consising of two crosslinked D-fragments of fibrin. A longer explanation, with pictures and extensive bibliography, is also available. The presence of an elevated D-dimer confrms that somewhere fibrin is being degraded.

 

References

Slofstra, Sjoukje, Arnold Spek, and Hugo ten Cate. "Disseminated intravascular coagulation." The Hematology Journal 4.1 (2013): 295-302.

 

Levi, Marcel, and Hugo Ten Cate. "Disseminated intravascular coagulation."New England Journal of Medicine 341.8 (1999): 586-592.

 

Letsky, Elizabeth A. "Disseminated intravascular coagulation." Best Practice & Research Clinical Obstetrics & Gynaecology 15.4 (2001): 623-644.

 

Carr, J. Meehan, M. McKinney, and J. McDonagh. "Diagnosis of disseminated intravascular coagulation. Role of D-dimer." American journal of clinical pathology 91.3 (1989): 280-287.

 

Adam, Soheir S., Nigel S. Key, and Charles S. Greenberg. "D-dimer antigen: current concepts and future prospects." Blood 113.13 (2009): 2878-2887.