Well friends, we have discussed the causes and investigations of DIC. Now here let’s take a look at its management. Management of DICThe most important step is to terminate the pregnancy- vaginal delivery without episiotomy is preferred to cesarean section Volume replacement by crystalloids or colloids will reduce the amount of whole blood needed to restore the blood volume. 500 ml of fresh blood raises the fibrinogen level approximately by 12.5 mg/100 ml and platelets by 10,000–15,000 cu mm. Fresh blood- helps in flushing out fibrin degradation product and improving the micro circulation. To replace fibrinogen- Fresh frozen plasma should be given: Fresh frozen plasma (FFP) is extracted from whole blood. It contains fibrinogen, anti-thrombin III, clotting factors V, XI, XII. FFP transfusion provides both volume replacement and coagulation factors. One unit of FFP (250 mL) raises the fibrinogen by 5-10 mg/dL. FFP does not need to be ABO or Rh compatible. Cryoprecipitate is obtained from thawed FFP. It is rich in fibrinogen, factor VIII, Von Willebrand’s factor, and XIII. Cryoprecipitate provides less volume (40 mL) compared to FFP (250 mL). So it should not be used for volume replacement. One unit of cryoprecipitate increases the fibrinogen level by 5-10 mg/dL. In case of active bleeding with platelet counts < 50,000/ml or prophylactically with platelet count 20–30,000/ml – platelet replacement should be done. Platelet should ABO and Rh specific. 1 units (50 ml) raises the platelet count by 7500/ ml Recombinant activated factors VIIA: (60-100 μg/kg IV) can reverse DIC within 10 minute as it is a precusor for extrinsic clotting cascade which is replaced. Role of HeparinAccording to Williams Obs. “Heparin is not used in DIC.” According to COGDT 10/e, p 999 “Heparin acts as an anticoagulant by activating antithrombin III but has little effect on activated coagulation factors. Anticoagulation is contraindicated in patients with fulminant DIC and central nervous system insults, fulminant liver failure, or obstetric accidents. The one instance, however, in which heparin has been demonstrated to benefit pregnancy-related DIC is in the case of the retained dead fetus with intact vascular system, where heparin may be administered to interrupt the coagulation process and thrombocytopenia for several days until delivery may be implemented.” As far as EACA is concerned- Williams Obs. 22/e, p 844 says – “EACA is not recommended in case of DIC.” According to Williams Obs 23/e, p 787 “It use in most types of obstetric coagulopathy has not been efficacious & not recommended”