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.