Discussion on perioperative anesthesia rescue treatment for DIC parturients with severe placental abruption

Background: To investigate perioperative anesthesia rescue treatment method and effect of DIC parturients with severe placental abruption. Methods: Designed as a retrospective inductive analysis, the present study included 6 parturients of DIC with severe placental abruption who were admitted to Dalingshan Hospital of Dongguan City from January 2013 to December 2018. The research further studied and analyzed the perioperative anesthesia treatment of 6 DIC parturients with severe placental abruption. Observation indicators included (1) Preoperative evaluation, (2) Intraoperative conditions, and (3) Follow-up after operation. Results: (1) Preoperative evaluation: 25 cases of severe placental abruption were grade III ASA, including 3 stillbirths. (2) Intraoperative conditions: 6 cases of DIC parturients were confirmed to have severe placental abruption, including 3 stillbirths. (3) Postoperative follow-up: All the 6 parturients were cured without any complications. Conclusion: Standardized rescue processing method with multidisciplinary cooperation, rapid and advanced intervention, and simultaneous multiple measures can improve the operative safety of parturients with placental abruption.

Disseminated intravascular coagulation (DIC) combined with placental abruption is a rare complication during caesarean section, which, however, is characterized by fierce trend, rapid progress, dangerous condition and high mortality. Without prompt and proper management, it may endanger the lives of both mothers and infants [1][2] [3]. There were 79 cases of placental abruption (0.76%), among which 25 cases (0.24%) were severe placental abruption and 6 DIC parturients (0.06%) with severe placental abruption.
The perioperative anesthesia rescue treatment of 6 DIC parturients with severe placental abruption was studied and analyzed. Observation indicators were: (1) Preoperative evaluation; (2) Intraoperative conditions; and (3) Follow-up after operation.

Inclusion and Exclusion Criteria
Inclusion criteria: Patients who met the diagnostic criteria of severe placental abruption (grade III) and DIC at the same time.
Exclusion criteria: Patients who did not meet the diagnostic criteria of severe placental abruption (grade III) and DIC.

1.
The presence of basic diseases that easily caused DIC, such as infection, malignant tumors, obstetric complications, large-scale surgery and trauma, etc.

2.
The presence of more than two clinical manifestations described below: (1) Multiple bleeding tendency; (2) Microcirculatory failure or shock which was not easily explained by the primary disease; (3) Symptoms and signs of multiple microvascular embolism, such as skin, subcutaneous, mucosal embolism and necrosis as well as early organ dysfunction such as kidney, lung and brain; 4 (4) Effective anticoagulant therapy.

3.
Laboratory tests met the following criteria (with three or more abnormalities simultaneously): (1) The platelet count was lower than 100×109 /L or progressively decreased.
(2) Fibrinogen was less than 1.5 g/L or progressively decreased, or more than 4.0 g/L; (3) The 3P test showed positive, FDP of fibrin degradation product was higher than 20 mg/L or D-dimer increased (positive).
(4) The prothrombin time (PT) shortened or prolonged for more than 3 s or activated partial thromboplastin time (APTT) prolonged for more than 10 seconds.
(5) Antithrombin and molecular markers of coagulation, fibrinolysis and platelet activation might be considered for patients with difficult miscellaneous diseases or other particularities.
(6) The percentage of fragmented red cells in peripheral blood was more than 10%.
The diagnostic criteria of DIC can be simply summarized as "123", i.e., 1 was susceptible to basic diseases, 2 represented more than 2 clinical symptoms, and 3 showed that there were at least 3 positive items for related laboratory tests.

Methods
The study adopted retrospective inductive analysis. Six parturients of DIC with severe  All authors agree to publish.
-Availability of data and materials All the data and materials are availability for research.

-Competing interests
The authors declared that they have no conflicts of interest to this work. -Funding Not applicable -Authors' Contributions As the communication author, Hua Wang provided the main ideas and writing of the thesis. Shihong Wang collected and processed the first-hand data as the first author and communicated with the participants.
-Acknowledgements Not applicable