Quantitative Evaluation of Coagulability in Obstetric DIC Using TEG6s for New Japanese Diagnostic Criteria of Obstetrical Disseminated Intravascular Coagulation.

Obstetric disseminated intravascular coagulation (DIC) onset is indicated by a bleeding tendency; however, its quantitative evaluation is difficult. Here, we quantitatively evaluated coagulability using the blood viscoelasticity test, TEG6s, for determining the threshold at which bleeding tendency occurs based on coagulation function test results and bleeding volume. This retrospective, observational study included 33 cases with potential obstetric DIC. For the coagulation blood test, we evaluated fibrinogen, fibrin/fibrinogen degradation products (FDP), platelet count, prothrombin time (PT), activated partial thromboplastin time (aPTT), hemoglobin, and bleeding amount. We evaluated using TEG6s blood viscoelasticity. Among the measurement items related to viscoelasticity in TEG6s, we used MA (maximum amplitude)-CRT. The causes of bleeding among the 33 cases included: atonic hemorrhage, 13; placenta previa, 11; amniotic fluid embolism, three; hypertension disorder of pregnancy, two; and others, four. Bivariate analysis showed a significant positive correlation between MA-CRT and fibrinogen and FDP. Inverse estimated values calculated using a nonlinear regression model for each test item showed the following results: MA-CRT < 46.6 mm and MA-CRT < 50 mm: fibrinogen, 135.4 mg/dL and 157.7 mg/dL; and FDP, 79.5 μg/mL and 60.8 μg/mL. In summary, fibrinogen and FDP indicated bleeding tendency, with recommended threshold values being 150 mg/dL and 60 μg/mL, respectively.