Zentralblatt für Gynäkologie
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There is reported on a 35 years old woman, who was delivered of her third child. Six days after the expected day of delivery labour was introduced. On the end of the second stage an amniotic fluid infusion happened. ⋯ Within four hours she received 22 units of blood and 27 units of coagulo-active substance because of severe coagulation defect. After restoration of coagulability of blood hysterectomy had to follow owing to uterine rupture which in the first instance was overlooked. Woman and child survived.
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The syndrome of coagulation defects in obstetrics was detected as cause for obstetrical hemorrhage during the 50 years. Some of the etiologic factors like the dead fetus syndrome or the salting out syndrome have vanished. Amniotic fluid embolism is the only syndrome which is clearly associated with disseminated intravascular coagulation. ⋯ One concept assumes that the plasma fibrinogen concentration is low because it is consumed in the retroplacental hematoma. Heparin treatment can be fatal if DIC is mistaken with a "loss coagulopathy", which is at present mostly responsible for coagulation defects and obstetrical hemorrhage. This indicates a change in pattern of disease which is due to a better pathophysiologic understanding.