Uterine Intravascular Fetal Material and Coagulopathy at Peripartum Hysterectomy

Background/Aims: To test the hypothesis that obstetrical disseminated intravascular coagulopathy results from an excessive leakage of fetal material into the maternal circulation. Methods: All peripartum hysterectomy cases for hemorrhage at two suburban Illinois hospitals over 10 years were included. Intravascular presence of fetal material was determined by two pathologists blinded to each other and to any clinical information. For a given diagnosis, the percentage of intravascular fetal material in those patients with the diagnosis was compared with those without that diagnosis using Fisher’s exact test. Results: Seven diagnoses were attributed to the etiology of the hemorrhage: uterine rupture, abruption, uterine atony, placenta previa, accreta, coagulopathy, and retained placenta. Each of these diagnostic categories had fetal material present – ranging from 20 to 33%, but there were no statically significant differences. Secondary outcome measures of morbidity demonstrated that blood transfusion and intraoperative bladder injury were the chief comorbidities of peripartum hysterectomy. Conclusion: Maternal intravascular fetal material at the time of peripartum hysterectomy is present in up to one third of patients and does not invariably result in disseminated intravascular coagulopathy.