Coagulation Defects in Severe Intrapartum and Postpartum Hemorrhage

• The coagulability of the blood becomes defective in certain obstetric complications, especially in the severe forms of premature separation and after fetal death in utero. The first case here described involved severe premature separation of the placenta with intrauterine fetal death; the patient was delivered by abdominal hysterotomy and recovered after several transfusions and the intravenous administration of fibroinogen. In the second case there was spontaneous delivery of a macerated fetus, but the patient had persistent bleeding with symptoms of shock and likewise required whole blood and fibrinogen. Obstetric patients are able generally to withstand moderate losses of blood without shock; consequently, when shock does appear, it may mean that the patient is nearly exsanguinated. Detection and treatment of the syndrome of hypofibrinogenemia may be of crucial importance in such patients. If fetal death occurs, the mother should have a weekly clotobservation test. The clotting mechanism should be corrected before any obstetric procedure is completed, and this is readily accomplished by transfusion and fibrinogen.