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Eclampsia, Preeclampsia, and Disseminated Intravascular Coagulation

From the Department of Obstetrics and Gynecology. University of Vermont College of Medicine, Burlington, Vermont

Abstract

Severe toxemia of pregnancy should he included in any discussion of coagulation defects. We have recently cared for 2 severely preeclamplic and 3 eclamplic patients who demonstrated varying degrees of disseminated intravascular coagulation. All patients recovered without sequelae; 2 of the fetuses died. One patient with hepatic rupture represents only the second eclainpttc to have survived this complication, despite her associated cardiopulmonary and renal failure. In such diagnoses a low platelet count is probably the single most important finding. Fibrinogen levels may be only slightly depressed, or even normal, in the face of severe fibrin deposition. Hemolysis, deformed red cells, abnormal hepatic function, urinary casts, and elevated BUN also occur. The severity of the clotting dysfunction does not always correlate with the severity of the toxemic process; convulsive thresholds in particular are not consistently related to the severity of the coagulopathy. In these cases heparin was given to 3 women, 2 of whom were delivered while being heparinized. Preliminary clinical laboratory data suggest that this drug, when added to a magnesium sulfate regimen, can improve organ function in toxemia prior to delivery.