A 33-year-old woman was admitted to our hospital with severe DIC, liver dysfunction and renal failure. She presented at 31 weeks of a twin pregnancy that was effected by intracytoplasmic sperm injection. Two weeks previously, the patient had presented with elevated serum transaminase levels [416 U/l aspartate aminotransferase (AST) and 406 U/l alanine aminotransferase (ALT)] and she was serologically negative for viral hepatitis B and C. At the time of admission, the patient had jaundice, and oedema in her ankles. Serum biochemistry showed a creatinine level of 203·2 μmol/l, AST 145 U/l, ALT 146 U/l, bilirubin 65 μmol/l and lactate dehydrogenase 390 U/l. A complete blood count showed a white cell count of 14·3–109/l (82% neutrophils and 12% lymphocytes), a platelet count of 122–109/l and a haemoglobin level of 12·2 g/dl, with normal blood cell morphologies. A prothrombin time (PT) of 27 s was recorded, with an activated prothrombin time of longer than 60 s, plasma fibrinogen (FG) levels of 5·6 g/l and d-dimers at 6·78 mg/l. With the diagnosis of severe DIC, a caesarean section was performed after transfusion with fresh-frozen plasma (FFP) and FG. The patient subsequently became haemodynamically unstable, with hypotension and oliguria. Haemoglobin levels decreased markedly, coagulopathy persisted in spite of the transfusion of FFP and FG, and abdominal echography revealed the presence of significant intra-abdominal bleeding. A further surgical procedure was performed, with drainage of 3 l of intra-abdominal blood, although no clear bleeding point was evident. A hysterectomy was then performed. Despite this intervention, the patient remained haemodynamically unstable, with coagulopathy and decreasing haemoglobin levels and platelet counts, although intensive transfusions with red blood cells (RBCs), platelets (PPTs), FFP and FG were maintained. Another laparotomy was carried out on the third day, with drainage of a large amount of intra-abdominal blood; a small bleeding point in the left parametrium was identified, which was ligated. However, massive intra-abdominal bleeding persisted, together with severe DIC and decreasing haemoglobin levels that reached 3·5 g/dl. At this point, new surgical procedures were eschewed and treatment with rFVIIa was begun, with the administration of two single doses of 90 μg/kg at 3-hourly intervals. A response was clearly observed after the first two doses. The patient became haemodynamically stable with adequate diuresis and a good response to transfusions. After the first hours of treatment, haemoglobin levels increased significantly. Treatment with rFVIIa was continued at the same dose every 3 h, for a total of nine doses. Supportive treatment with FFP, RBCs and PPTs was maintained. The outcome was favourable, with resolution of DIC, liver dysfunction and renal failure. Figure 1 shows the condition of the patient before and after treatment with rFVIIa, in terms of haemoglobin levels, PPT count, PT, FG levels and d-dimers respectively.