Hemostatic abnormalities at the time of fetal death: A retrospective study evaluating the prevalence and relevance of targeted testing.

OBJECTIVE

To assess the prevalence of hemostasis abnormalities at the time of fetal death diagnosis.

METHODS

This retrospective single-center study included all fetal deaths between 22 and 42 weeks from July 2017 to December 2023, excluding multiple pregnancies, patients on anticoagulant therapy, and those with known pre-existing coagulation disorders. Hemostatic abnormalities were classified as: (1) probable disseminated intravascular coagulation (DIC), defined by a modified International Society on Thrombosis and Hemostasis (ISTH) probability score above 25, and (2) confirmed DIC, requiring clinical diagnosis with transfusion, intensive care admission, or maternal death. To evaluate this score and hemostasis abnormalities, platelet count, prothrombin time difference (PT), activated partial thromboplastin time (aPTT) and fibrinogen level are described. Maternal characteristics and obstetrical history were evaluated to identify a high-risk of DIC situation such as sepsis, placenta abruption and hypertensive disorders of pregnancy. Etiology of fetal death are also described, searching for a vascular etiology. Cases of confirmed DIC are detailed.

RESULTS

Among 163 cases of fetal death, 12 women (7.4%) had probable DIC, and three women (1.8%) had confirmed DIC. When the initial blood test was normal, none of the subsequent blood tests revealed any abnormalities. The main causes of fetal death included vascular-related intrauterine growth restriction (42%), unexplained deaths (19%) and fetal malformations (14%). Two cases of confirmed DIC were associated with retroplacental hematomas, while the third involved severe intrauterine growth restriction (IUGR) with pathologic uterine Dopplers, suggesting a vascular etiology.

CONCLUSION

The risk of confirmed DIC in the context of fetal death is low (1.8%) and primarily associated with retroplacental or vascular pathologies. These findings support a selective approach to hemostasis testing based on clinical context rather than routine systematic testing.