What are the key differences in the management of DIC associated with obstetric complications versus that associated with malignancy?

Key differences in the management of disseminated intravascular coagulation (DIC) associated with obstetric complications compared to malignancy:

• Obstetric-related DIC management: Management focuses on rapid identification and treatment of the underlying obstetric cause (e.g., placental abruption, amniotic fluid embolism, severe pre-eclampsia, or postpartum hemorrhage) with multidisciplinary involvement including obstetricians, haematologists, and anaesthetists to optimise maternal and fetal outcomes. Active management of the third stage of labour is recommended to reduce bleeding risk, and careful monitoring of blood loss and haematological parameters is essential. Regional analgesia and anaesthesia decisions are modified based on platelet counts and bleeding risk. Uterotonics should be given cautiously, avoiding intramuscular injections in women with bleeding disorders. Postpartum care includes monitoring for secondary bleeding and informing women about bleeding risks after discharge ¹.
• Malignancy-associated DIC management: The primary approach is to treat the underlying malignancy aggressively, as DIC is often chronic and related to cancer progression. Supportive care includes careful anticoagulation balancing bleeding and thrombosis risks, often guided by haematology specialists. Unlike obstetric DIC, there is less emphasis on acute obstetric interventions and more on systemic cancer therapy and managing complications of chronic DIC. Baseline and ongoing coagulation and blood counts are monitored, and treatment is tailored to the patient's overall condition and cancer status ³.
• Summary of differences: Obstetric DIC requires urgent obstetric interventions and multidisciplinary peripartum care with active management of labour and bleeding, while malignancy-associated DIC management centres on cancer treatment and balancing anticoagulation with bleeding risk. Obstetric DIC is often acute and reversible with delivery and haemostatic support, whereas malignancy-associated DIC tends to be chronic and linked to cancer progression ¹,³.