Pregnancy-Modified DIC Score Parameters and Clinical Characteristics
Explore a detailed breakdown of the pregnancy-modified DIC score parameters based on the study by Erez et al. 2014, along with maternal baseline characteristics, clinical presentations, management, and complications associated with DIC. The tables provide valuable insights into the scoring criteria, patient demographics, signs and symptoms, imaging tests, treatment modalities, and outcomes related to DIC in pregnancy.
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Supp. Table 1 Pregnancy-modified DIC score by Erez et al 2014 Parameters Modified ISTH score Platelet count, 109/L <50 = 1 50-100 = 2 100-185 = 2 >185 = 0 Prothrombin time (value of patient/normal value) <0.5 = 0 0.5-1 = 5 1.0-1.5 = 12 >1.5 = 25 Fibrinogen level, g/L 3.0 = 25 3.0 -4.0 =6 4.0 -4.5 = 1 >4.5 = 0 Calculated score >26 high probability for DIC
Supp. Table 2 Maternal baseline Characteristics Supp. Table 2. Maternal baseline Characteristics 3 Patient No. 1 2 4 5 6 7 Mean Maternal age (y) 32 31 38 29 37 43 30 34 Ethnicity Bedouin Bedouin Bedouin Jewish Jewish Jewish Bedouin Parity Gestational age (wk) G6P5 36 G1P0 37 G7P6 40 G4P3 29 G3P1 39 G3P2 34 G4P3 39 3 36.2 Hypertension antepartum Mild Preeclampsia None Severe Preeclampsia Gestational hypertension Chronic hypertension Severe Preeclampsia None HELLP syn postpartum Severe Preeclampsia Severe Preeclampsia Severe Preeclampsia and HELLP syn HELLP syn Mode of delivery Cesarean section Vaginal Cesarean section Vaginal Cesarean section Cesarean section Cesarean section Preeclampsia and hypertensive disorders of pregnancy are defined according to: Sibai BM. Diagnosis and Management of Gestational Hypertension and Preeclampsia. Obstet Gynecol. 2003 Jul;102(1):181-92. and: ACOG Committee on Practice Bulletins-Obstetrics: Diagnosis and management of preeclampsia and eclampsia. Obstet Gynecol 99:159, 2002.
Supp. Table 3 Clinical presentation, management and complication Supp. Table 3. Clinical presentation, management and complication 1 Signs and symptoms Hemorrhagic shock Patient No. 2 Epigastric pain 3 Not mentioned 4 Epigastric pain, Abdominal pain, vomiting Imaging tests No Subcapsular liver hematoma per CT scan Liver hematoma per US, Liver rupture per CT scan No Medical treatment: antihypertensive other Hydralazine Hydralazine Not mentioned Not mentioned MgSo4, Ampicillin, Gentamycin, Metronidazole MgSo4 Not mentioned Recombinant factor VIIa, Tranexamic Acid, Vasopressors, Clindamycin, Ceftazidime, Amoxicillin Clavulanic Acid Blood units and products 24 packed cells 12 platelets 7 FFP 2 FFP 2 packed cells 2 FFP 97 platelets 35 cryoprecipitate 30 packed cells 25 FFP Treatment modality Surgical liver packing Conservative Conservative Surgical liver packing Short and long term complications DIC HELLP HELLP Placental abruption, HELLP, Acute renal failure, Pulmonary congestion, Peritoneal abscess Length of stay (d) Maternal mortality FFP=fresh frozen plasma 1 Yes 9 No 11 No 24 No
Supp. Table 3 Clinical presentation, management and complication cont. Supp. Table 3. Clinical presentation, management and complication Cont. 6 Hemorrhagic shock Epigastric pain No Free air under diaphragm on CXR, Subcapsular liver hematoma per CT scan Patient No. Signs and symptoms Imaging tests 5 7 Hemorrhagic shock No Medical treatment: antihypertensive Not mentioned Hydralazine, Captopril, Atenolol Not mentioned other Ampicillin, Gentamycin, Metronidazole MgSo4, Ceftriaxone, Piperacillin/ Tazobactam Recombinant factor VIIa ,MgSo4, PGF2A, Ampicillin /Sulbactam, Imipenem, Meropenem, Fluconazole, Vancomycin Blood units and products 10 platelets 10 cryoprecipitate 8 packed cells 6 FFP 5 packed cells 4 FFP 4 platelets 30 cryoprecipitate 20 platelets 17 FFP 16 packed cells Treatment modality Surgical liver packing Surgical laparotomy Surgical liver packing, Hepatic artery ligation Short and long term complications Length of stay (d) Maternal mortality HELLP, DIC, Peritoneal abscess 30 No HELLP, Prolonged fever Placental abruption, DIC, Sepsis, Cerebral aneurysm 22 No 25 No
Supp. Table 4 Laboratory abnormalities Supp. Table 4. Laboratory abnormalities Patient No. 1 2 3 4 5 6 7 Lowest Hemoglobin Concentrations g/dL 3.5 8.7 8.4 6.7 8.4 6.5 2 Lowest Platelet Conentrations *10^3/uL N/A 38 43 57 43 34 38 Lowest Fibrinogen Concentrations g/L 1.76 3.47 3.9 0.85 2.35 2.96 N/A Longest Prothrombin time Sec N/A 19.3 16.8 20.8 19.9 15.6 17.1 Prothrombin time (value of patient/control value) N/A 1.46 1.24 1.51 1.63 1.36 1.3 Highest AST level U/L 435 1,899 4,482 2,794 604 5220 220 Highest ALT level U/L N/A 661 2,331 1,613 507 3820 131 Highest LDH level N/A 8,004 8,820 3,515 1,535 6884 1,001 AST= Aspartate transaminase, ALT=Alanine transaminase, LDH= Lactate dehydrogenase
