Japanese Obstetric DIC Algorithm

NOTE: Whilst we have done our utmost to ensure the accuracy of the data in this section, users should access the original publications. This will also allow you to see how the algorithm was created, the population studied and any limitations to the study.

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1. There are a number of causes for DIC in pregnancy and these include:
  Sepsis
  Placental Abruption
  Severe Hypertension
  Retained stillbirth
  Amniotic fluid embolism
  Acute fatty liver of pregnancy
  HELLP
  Severe Obstetric Haemorrhage

1. Erez O, Novack L, et al. DIC score in pregnant women--a population based modification of the International Society on Thrombosis and Hemostasis score. PloS one. 2014; 9: e93240.

2. Papageorgiou C, Jourdi G, et al. Disseminated Intravascular Coagulation: An Update on Pathogenesis, Diagnosis, and Therapeutic Strategies. Clin Appl Thromb Hemost. 2018: 1076029618806424.

3. Rabinovich A, Abdul-Kadir R, et al. DIC in obstetrics: Diagnostic score, highlights in management, and international registry-communication from the DIC and Women's Health SSCs of the International Society of Thrombosis and Haemostasis. J Thromb Haemost. 2019; 17: 1562-6.

4. Click HERE to access the RCOG guideline on Thromboembolic Disease in Pregnancy and the Puerperium.

5. Erez O, Othman M, Rabinovich A, et al. DIC in Pregnancy - Pathophysiology, Clinical Characteristics, Diagnostic Scores, and Treatments. J Blood Med. 2022;13:21-44.

5. Morikawa M, Kamiya A, Yoshida A, et al. Differences between Japanese new criteria and pregnancy-specific modified ISTH DIC scores for obstetrical DIC diagnosis. Int J Hematol. 2024;119(3):265-74.

6. Morikawa M, Takeda Y, Matsunaga S, et al. Effectiveness, reliability, and validity of new Japanese diagnostic criteria for obstetrical disseminated intravascular coagulation. Sci Rep. 2024;14(1):17677.

7. Wolfovitz A, Brenner B, Solt I. Postpartum Disseminated Intravascular Coagulation: A Comprehensive Review of Pathophysiology, Diagnosis, Management, and Prevention. Semin Thromb Hemost. 2025.

I. Underlying Disease/Pathology [Select only one]
	Placental Abruption	4 Points
	Amniotic Fluid Embolism	4 Points
	Postpartum haemorrhage with coagulopathy	4 Points
II. Coagulopathy Finding Fibrinogen [mg/dL]
	Fibrinogen ≥300 mg/dL	0 Points
	Fibrinogen ≥200 - <300 mg/dL	1 Point
	Fibrinogen ≥150 - <200 mg/dL	2 Points
	Fibrinogen <150 mg/dL	3 Points
III. Fibrinolysis Finding [Select either A or B]
A. FDP [µg/mL]
	<30 µg/mL	0 Points
	≥30 - <60 µg/mL	1 Point
	≥60 µg/mL	2 Points

B. D-dimer [µg/mL]
	<15 µg/mL	0 Points
	≥15 - <25 µg/mL	1 Point
	≥25 µg/mL	2 Points

	- Changes -
	Increase	Decrease	No Change
Clotting Factors	Fibrinogen Factors II, V, VII, VIII, IX and X von Willebrand Factor [VWF]	Factor XI
Anticoagulant Proteins	Soluble Thrombomodulin [Tm]	Protein S	Protein C Antithrombin
Proteins involved in Fibrinolysis	PAI-1 PAI-2	t-PA	TAFI
Placenta	Tissue Factor [TF]	TFPI

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Interpretation of Score
≥8	Obstetrical DIC is diagnosed if the Total of all three factors is ≥8 points