Hypofibrinogenemia and gradual activation of the fibrinolytic system may occur in the mother whenever a dead fetus is retained in utero one week or longer, members of the American College of Obstetricians and Gynecologists were told at their twelfth annual meeting.
A diagnosis of intrauterine fetal death is thus an indication for close observation of fibrinogen levels in the mother, said Louise Lang Phillips, PhD, and T. M. King, MD, Columbia University and Columbia-Presbyterian Hospital, New York. Fibrinolysin is apparently not activated in the absence of hypofibrinogenemia. They suggested that preparations be made for treatment with both fibrinogen and a fibrinolysin inhibitor.
Even when hypofibrinogenemia develops, however, most patients deliver the dead fetus with minimal blood loss and without need for fibrinogen therapy, they said. Severe bleeding develops only occasionally—perhaps, they theorized, when the rate of fibrinolysin activation exceeds the rate of destruction. Their data, obtained in a study of