Abstract
Introduction: Disseminated intravascular coagulation due to placental abruption with intrauterine fetal death is not
uncommon. It can result in increased maternal mortality rates and the need for hysterectomy or greater transfusion
volumes if the delivery is not completed within six to eight hours. However, consensus is lacking regarding the
delivery approach for cases in which delivery is prolonged.
Case presentation: A 37-year-old Japanese woman was transported to our tertiary center two and a half hours
after the onset of labor because of a diagnosis of placental abruption with intrauterine fetal death at 40 weeks and
three days’ gestation. On arrival, although severe hypofibrinogenemia was observed, there was no external hemorrhage.
Because her cervical canal dilation was good (Bishop score, 7), labor was induced using oxytocin. Anti-disseminated
intravascular coagulation therapy was simultaneously started via transfusion. After her hypofibrinogenemia resolved,
delivery progressed rapidly, and the fetus was delivered approximately 10 hours after the onset. To reduce postpartum
hemorrhage, 6g of fibrinogen concentrate and tranexamic acid, an antifibrinolytic agent, were administered
immediately before extraction of the dead fetus and placenta. Although the amount of intrapartum hemorrhage
was 1824g, there was no abnormal bleeding after delivery, and our patient was discharged three days later.
Conclusion: In cases of placental abruption complicated with disseminated intravascular coagulation,
intrapartum administration of coagulation factors can simultaneously promote effective labor and correct
hypofibrinogenemia, enabling minimally invasive vaginal delivery.
Keywords: DIC, Intrauterine fetal death, Placental abruption, Vaginal delivery