May 30, 2019
Disseminated intravascular coagulation (DIC) occurs in 12.5 out of 10,000 delivery hospitalizations, resulting in death of the mother in 6% of cases, according to a College of Community Health Sciences Grand Rounds discussion led by Drs. Connie Leeper, Vanessa Hamby and Amrit Sidhu.
DIC is a condition where blood clots form in the body blocking small vessels. It is often seen in cases of sepsis, severe trauma and serious pregnancy complications.
In obstetrics cases of DIC, three key risk factors have been observed: placenta abruption (37%), peripartum hemorrhage (29%) and preeclampsia (14%).
Sidhu, a resident with The University of Alabama Family Medicine Residency, which is operated by CCHS, explained the four R’s of dealing with cases of DIC that are essential for preventing and treating the condition: readiness, recognition, response and reporting.
Leeper, assistant professor at CCHS and a family medicine-obstetrician who practices at University Medical Center, which the College operates, explained the stages of treatment for DIC and uncontrolled bleeding. The Massive Transfusion Protocol set in place and defined by DCH Regional Medical Center must be followed to ensure timely and efficient response.
Additionally, a Bakri balloon was used to try to control the hemorrhage in the specific case discussed during the May Grand Rounds. The doctors explained how the balloon functioned and when to implement it in the case of significant bleeding. The Bakri balloon is filled with fluid, and it adapts to the configuration of the uterine cavity to tamponade the bleeding.
A few of the topics covered were the need for proper labels, a runner for the blood bank, and having the required blood products thawed and in an insulated container.
Hamby, also a resident with the UA Family Medicine Residency, reiterated the importance of keeping a patient’s family informed of the progress of the surgery so they can be prepared.
The College’s Grand Rounds series, which provides Continuing Medical Education for physicians and other health professionals, is designed to help medical professionals and learners look at past cases and learn from the investigative process. In this case, the doctors assigned had to step back and look at all the information while using a hands-on approach with the patient to make a successful diagnosis.