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ISTH DIC Scoring Algorithm:
Modifications for use in Pregnancy

Introduction:

DIC is a recognised cause of maternal mortality and a modification of the ISTH DIC Scoring algorithm was developed for use in pregnancy.  The modifications are necessary due to the changes in haemostasis that occur in normal pregnancy. The use of three components of the ISTH DIC score - Platelet count, Fibrinogen and differences in PT [compared to a normal laboratory control] allowed the development of an algorithm with a sensitivity of 88% and a specificity of 96% for the diagnosis of DIC. D-dimers were excluded as the levels rise in pregnancy and substantially after 20 weeks in pregnancy.

The ISTH DIC Score - Pregnancy:


Select Criteria:

Platelet Count
<50 x 109/L 1 Point
50 - 100 x 109/L 2 Points
100 - 185 x 109/L 1 Point
>185 x 109/L 0 Points
Prothrombin Time [PT] Difference [s]1
<0.5 0 Points
0.5 - 1.0 5 Points
1.0 - 1.5 12 Points
>1.5 25 Points
Fibrinogen [Clauss] Level
≤3.0 g/L 25 Points
3.0 - 4.0 g/L 6 Points
4.0 - 4.5 g/L 1 Point
≥4.5 g/L 0 Points

1Defined as the difference between the result of the patient and that of the laboratory normal control.

Score

[Max score 52]

Interpretation of Score
≥26 Sensitivity of 88% and a specificity of 96% for the diagnosis of DIC


Haemostatic Changes in Pregnancy

Pregnancy induces a hypercoagulable state and which arises from a number of changes that occur in the coagulation system:

  - 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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Comments

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.

All information contained in this section of Practical-Haemostasis.com. is provided for educational purposes only. This information should not be used for the diagnosis or treatment of any health problem or disease.

The user of Practical-Haemostasis.com assumes sole responsibility for any decisions made or actions taken based on the information contained herein.

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
  Sepsis

LINKS & References

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.

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

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Updated:         22-Aug-2025