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Obstetrics and gynaecology
Disseminated intravascular coagulopathy and subsequent kidney injury requiring dialysis after a second-trimester dilation and evacuation procedure
  1. Shilpa Melanie Darivemula1,
  2. Clay Block2,
  3. Gauri Luthra3 and
  4. Amy Paris3
  1. 1Department of Obstetrics and Gynecology, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
  2. 2Department of Medicine, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire, USA
  3. 3Department of Obstetrics and Gynecology, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire, USA
  1. Correspondence to Dr Shilpa Melanie Darivemula; shilpa_darivemula{at}med.unc.edu

Abstract

A primigravida in her 20s with a body mass index of 18 underwent dilation and evacuation at 22 and 4 weeks gestational age to manage an intrauterine fetal demise (IUFD) that had occurred 14 days ago. Hypoxaemia and vaginal bleeding developed 90 min postprocedure. Investigations demonstrated changes compatible with acute respiratory distress syndrome secondary to disseminated intravascular coagulopathy which was managed with intubation, mechanical ventilation and transfusion of blood products. Although the coagulopathy and respiratory failure resolved, severe acute kidney injury ensued resulting in acute tubular necrosis, severe labial oedema and the need for prolonged support with haemodialysis until kidney recovery 7 weeks later.

  • Abortion
  • Reproductive medicine
  • Acute renal failure
  • Adult intensive care

https://doi.org/10.1136/bcr-2023-258462

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    Footnotes

    • Contributors The following authors were responsible for drafting of the text, sourcing and editing of clinical images, investigation results, drawing original diagrams and algorithms, and critical revision for important intellectual content: SMD was responsible for the drafting of the text and sourcing and editing all clinical images. GL, CB and AP assisted in editing clinical images and contributing to investigation results, as well as providing critical revisions for important intellectual content. AP acted as guarantor. The following authors gave final approval of the manuscript: SMD, AP, GL and CB.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.