Determinants of Disseminated Intravascular Coagulation in Patients with Postpartum Hemorrhage: A Study from Androva University Hospital, Madagascar

Introduction: Disseminated intravascular coagulation (DIC) represents one of the most serious complications of postpartum hemorrhage (PPH) and remains an important contributor to maternal mortality. The present study sought to determine the factors associated with the occurrence of DIC among women experiencing PPH.

Materials and Methods: A retrospective analytical case-control study was carried out between January 2020 and December 2024 in the obstetrics and gynecology department and the postoperative intensive care unit of Androva University Hospital. Women with PPH complicated by DIC were included as cases, whereas those with PPH without DIC served as controls, using a 1:3 ratio. Sociodemographic, obstetric, clinical, laboratory, therapeutic, and maternal-fetal outcome variables were collected and analyzed using SPSS version 26. Statistical significance was defined as a p-value <0.05.

Results: Eighty-eight parturients were included (22 cases, 66 controls). Systolic blood pressure <90 mmHg (OR=19.11; p=0.003), was significantly associated with DIC. Uterine atony was significantly associated with DIC (OR=5.57; p=0.001). Hemoglobin <70 g/L, thrombocytopenia <150 G/L, and prothrombin time <70% were also associated with DIC. Maternal mortality was significantly higher in cases (81.82% vs 9.09%; p<0.001).

Conclusion: DIC complicating PPH is associated with severe clinical and biological abnormalities and high maternal mortality, highlighting the need for early diagnosis and prompt multidisciplinary management.