Intrauterine fetal death and delivery complications associated with coagulopathy: a retrospective analysis of 104 cases.

OBJECTIVE

To assess the prevalence of delivery complications associated with coagulopathy in women with intrauterine fetal death (IUFD).

METHODS

This is a retrospective cohort study of women with IUFD at >24 weeks gestation or a birth weight of >500 g between 1994 and 2007. Clinical data were assessed by chart review.

RESULTS

One hundred four women were diagnosed with IUFD. The mean time between diagnosis of IUFD and delivery was 28.8 (+/-17.4) hours. Twelve of 104 (11.5%) women had a delivery complication associated with coagulopathy, defined as need for blood transfusion. In 8 of these 12 women, coagulopathy was associated with a preexisting preeclampsia/hemolysis, elevated liver enzymes, low platelet (HELLP) syndrome, uterine rupture after induction, or an acute clinical problem at presentation to the clinic. In 4 of 104 (4%) women, there was no attributable cause of coagulopathy other than IUFD. In these women, there was a statistically significant difference of laboratory parameters of coagulation at the time of diagnosis of IUFD compared with women who did not subsequently develop coagulopathy; platelet count 93.3 +/- 96.4 vs. 229.3 +/- 68.1 G/L, p < 0.001; prothrombin time (PT) 97.0 +/- 43.9 vs. 123.3 +/- 21.1 %, p = 0.02; activated partial thromboplastin time (aPTT) 42.9 +/- 34.0 vs. 31.5 +/- 4.3 sec, p = 0.01; thrombin time (TT) 22.8 +/- 16.5 vs. 14.1 +/- 13.3 sec, p = 0.02), plasma fibrinogen 219.0 +/- 117.5 vs. 472.9 +/- 122.8 mg/dL, p < 0.001), and antithrombin III 70.5 +/- 21.9 vs. 101.5 +/- 17.0 %, p = 0.01.

CONCLUSIONS

Delivery complications associated with coagulopathy occur in 11% of women with IUFD and are associated with preexisting preeclampsia/HELLP, uterine rupture, or an acute clinical problem in most cases. In 4% of women with IUFD, coagulopathy develops without an apparent cause.