Relation between disseminated intravascular coagulation, postpartum hemorrhage, and intrauterine infection

Intrauterine infection during pregnancy triples the risk of postpartum hemorrhage and severe PPH and increases the likelihood of maternal blood transfusion by two to three times compared to women without infection.

Haury J et al. recently evaluated the risk of disseminated intravascular coagulation (DIC) in postpartum hemorrhage (PPH) associated with intrauterine infection. Of 2,093 patients with PPH, they compared 49 exposed to a clinical intrauterine infection to 49 unexposed patients. They found that the rate of DIC was higher in patients with than without infection, and coagulation anomalies occurred sooner in patients with than without infection. They also found intrauterine infection as the only factor independently associated with DIC. Furthermore, 14% of this association between intrauterine infection and DIC was mediated by severe PPH, and 86% resulted from the direct effect of intrauterine infection on DIC.

This research proves that in PPH, intrauterine infection has a major direct effect on the occurrence, timing, and severity of DIC.

Haury J, Seco A, Goffinet F, Lepercq J. Risk of disseminated intravascular coagulation in postpartum hemorrhage associated with intrauterine infection. Journal of Gynecology Obstetrics and Human Reproduction. 2023;52(8). https://doi.org/10.1016/j.jogoh.2023.102626