IUFD, incomplete abortions, retained products

[coffeebythelake]

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Had a patient other day with large amount of retained products x4 months after a previous d+c. Not heavy on OBgyn in my daily practice, so perhaps some of you can give guidance on this. at what point do you consider getting DIC labs, or is this more dictated by patients clinical situation..? Is there even any value in getting them without clinical ssx?

 

[Propofool123]

If you’re considering a neuraxial for D&C and someone has had retained products for 4 months I would go ahead and get coags. If the patient is hemorrhaging or septic and you can’t wait long enough for coags to come back, then just do GA.

 

[chocomorsel]

Had a patient other day with large amount of retained products x4 months after a previous d+c. Not heavy on OBgyn in my daily practice, so perhaps some of you can give guidance on this. at what point do you consider getting DIC labs, or is this more dictated by patients clinical situation..? Is there even any value in getting them without clinical ssx?

How did she present? I am imagining pretty stable because if it’s been four months and the body hasn’t reacted, then maybe at this point it is not going to react. DIC and sepsis are not going to take four months to present.
You said no symptoms. How did they discover that she had retained products four months later? Bleeding? Foul discharge?
Never hurts to get coags on a patient you plan on doing neuroaxial with tho.

 

[coffeebythelake]

How did she present? I am imagining pretty stable because if it’s been four months and the body hasn’t reacted, then maybe at this point it is not going to react. DIC and sepsis are not going to take four months to present.
You said no symptoms. How did they discover that she had retained products four months later? Bleeding? Foul discharge?

Persistent discharge which prompted ultrasound by obgyn. Outpatient.

 

[chocomorsel]

Persistent discharge which prompted ultrasound by obgyn. Outpatient.

DIC presents with pretty obvious symptoms. Platelets normal?

 

[coffeebythelake]

DIC presents with pretty obvious symptoms. Platelets normal?

No labs. Zero. Not from obgyn office.

Pt appeared well overall. Discharge and some abd pain.

 

[chocomorsel]

No labs. Zero. Not from obgyn office.

Get some basic labs. Wouldn’t worry about DIC labs. She’d be oozing out of somewhere besides just her vagina.

 

[GassYous]

Not really worried about coags but I'd like to know the hgb and plt for when I see their name on the schedule again for the takeback. Geta with a type and cross because fool me once...

 

[Arch Guillotti]

If you’re considering a neuraxial for D&C and someone has had retained products for 4 months I would go ahead and get coags. If the patient is hemorrhaging or septic and you can’t wait long enough for coags to come back, then just do GA.

No way I would do neuraxial on a patient like this.

 

[chocomorsel]

No way I would do neuraxial on a patient like this.

So even if you did the labs and coats and they were fine, you still wouldn’t do a block?

 

[chocomorsel]

Has anyone ever seen chronic DIC? And how did it present?

 

[woopedazz]

I'd GA this patient regardless of bloods. She isn't wanting to be awake while they suction necrosed placenta/her miscarried child out of her... seems unnecessarily cruel to do a neuraxial

 

[deleted480308]

I'd GA this patient regardless of bloods. She isn't wanting to be awake while they suction necrosed placenta/her miscarried child out of her... seems unnecessarily cruel to do a neuraxial

Fully agreed. Physiologically necessary and psychologically appropriate aren’t always the same thing

 

[chocomorsel]

I'd GA this patient regardless of bloods. She isn't wanting to be awake while they suction necrosed placenta/her miscarried child out of her... seems unnecessarily cruel to do a neuraxial

Good point. They always go to sleep for me anyway. But we’re I to do a spinal there would be plenty of Versed on board as well.

 

[Arch Guillotti]

So even if you did the labs and coats and they were fine, you still wouldn’t do a block?

Not unless the patient insisted or some other mitigating circumstance.

 

[narcotics999]

Fully agreed. Physiologically necessary and psychologically appropriate aren’t always the same thing

Why is physiologically necessary? 10-20mins case no need for neuraxial

 

[deleted480308]

Why is physiologically necessary? 10-20mins case no need for neuraxial

I feel like there is a communication barrier

 

[WheezyBaby]

Chronic compensated DIC is an entity and retained products of conception are a known cause. I'm not intimate familiar with it but I wouldn't make the assumption you're going to see her hemmorhaging out her eyeballs if she has DIC