RSS-Feed abonnieren
DOI: 10.1055/s-0037-1617083
Obstetric bleeding complications
Publikationsverlauf
Publikationsdatum:
23. Dezember 2017 (online)
![](https://www.thieme-connect.de/media/10.1055-s-00034925/2006S02/lookinside/thumbnails/10-1055-s-0037-1617083-1.jpg)
Summary
The instability of the gestational and puerperal equilibrium of haemostasis is affected by a shift of primary and plasmatic haemostasis in a procoagulatory direction, whereas the regulation mechanism of the fibrinolytic system can easily cause disproportional peri- and postpartal reaction leading to massive haemorrhage. Peripartal injuries or an atonic uterus can lead to massive haemorrhage and cause a classic haemorrhagic coagulopathy. Complications like amniotic fluid embolism, puerperal sepsis, eclampsia or HELLP syndrom can lead through DIC to rapidly developing and possibly fulminant hyperfibrinolysis.
This article depicts different forms of haemorrhage in the peripartal situation, their particular pathologies and specific possibilities for management. A case study demonstrates the diagnostic and therapeutic options in the case of eclampsia with early abruption of placenta.
-
References
- 1 Abramov Y, Galun E, Granat M. et al. Postpartum systemic capillary leak syndrome: a possible etiology. Acta Obstet Gynecol Scand 1995; 74: 395-398.
- 2 Barton JR, Sibai BM. Hepatic imaging in HELLP syndrome (hemolysis, elevated liver enzymes, and low platelet count). Am J Obstet Gynecol 1996; 174: 1820-1827.
- 3 Baudo F, de Cataldo F. Italian Association of Haemophilia Centres (AICE): Register of acquired factor VIII inhibitors (RIIA).. Acquired factor VIII inhibitors in pregnancy: data from the Italian Haemophilia Register relevant to clinical practice. BJOG 2003; 110: 311-314.
- 4 Bombeli T. Management von Thrombosen und Blutungen. Bern: Huber; 2002
- 5 Esler MD, Douglas MJ. Planning for hemorrhage. Steps an anesthesiologist can take to limit and treat hemorrhage in the obstetric patient. Anesthesiol Clin North America 2003; 21: 127-144.
- 6 Haq G, Tayyab S. Control of postpartum and post abortal haemorrhage with uterine packing. J Pak Med Assoc 2005; 55: 369-371.
- 7 Heilmann L, voen Tempelhoff GF, Pollow K. Antiphospholipid syndrome in obstetrics. Clin Appl Thromb Hemost 2003; 9: 143-150.
- 8 Holmes VA. Changes in haemostasis during normal pregnancy: does homocysteine play a role in maintaining homeostasis?. Proc Nutr Soc 2003; 62: 479-493.
- 9 Jansen AJ, van Rhenen DJ, Steegers EA. et al. Postpartum hemorrhage and transfusion of blood and blood components. Obstet Gynecol Surv 2005; 60: 663-671.
- 10 Karowicz-Bilinska A, Kowalska-Koprek U, Suzin J. et al. Evaluation of some coagulation parameters in pregnant women with arterial hypertension]. Ginekol Pol 2003; 74: 55-60.
- 11 Kolben M, Graeff H. Hämostaseologische Störungen während der Schwangerschaft und Geburt: Pathogenese, Diagnose und Therapie. In: Müller-Berghaus G, Pötzsch B. (Hrsg). Hämostaseologie. Berlin, Heidelberg: Springer; 1998: 509-521.
- 12 Magann EF, Evans S, Hutchinson M. Postpartum hemorrhage after cesarean delivery: an analysis of risk factors. South Med J 2005; 98: 681-685.
- 13 Maki M, Kobayashi T, Terao T. et al. Antithrombin therapy for severe preeclampsia: results of a doubleblind, randomized, placebo-controlled trial. BI51.017 Study Group. Thromb Haemost 2000; 84: 583-590.
- 14 Mangione S, Giarratano A. The role of antithrombin III in critical patients in obstetrics. Minerva Anestesiol 2002; 68: 449-453.
- 15 Macklon NS, Greer IA. Venous thromboembolic disease in obstetrics and gynaecology: the Scottish experience. Scott Med J 1996; 41: 83-86.
- 16 Nwagha UI, Okaro JM, Nwagha TU. Intraoperative uterine packing with mops: an effective, but under utilized method of controlling post partum haemorrhage-experience from South Eastern Nigeria. Niger J Med 2005; 14: 279-282.
- 17 Ojala K, Perala J, Kariniemi J. et al. Arterial embolization and prophylactic catheterization for the treatment for severe obstetric hemorrhage. Acta Obstet Gynecol Scand 2005; 84: 1075-1080.
- 18 O’Riordan MN, Higgins JR. Haemostasis in normal and abnormal pregnancy. Best Pract Res Clin Obstet Gynaecol 2003; 17: 385-396.
- 19 Paternoster DM, Stella A, Simioni P. et al. Activated protein C resistance in normal and pre-eclamptic pregnancies. Gynecol Obstet Invest 2002; 54: 145-149.
- 20 Rath W, Heilmann L. Gerinnungsstörungen in Gynäkologie und Geburtshilfe. Stuttgart: Thieme; 1999
- 21 Sheiner E, Sarid L, Levy A. et al. Obstetric risk factors and outcome of pregnancies complicated with early postpartum hemorrhage: a population-based study. J Matern Fetal Neonatal Med 2005; 18: 149-154.
- 22 Shevell T, Malone FD. Management of obstetric hemorrhage. Semin Perinatol 2003; 27: 86-104.
- 23 Shih JC, Liu KL, Shyu MK. Temporary balloon occlusion of the common iliac artery: new approach to bleeding control during cesarean hysterectomy for placenta percreta. Am J Obstet Gynecol 2005; 193: 1756-1758.
- 24 Terao T, Kobayashi T, Imai N. et al. Pathological state of the coagulatory and fibrinolytic system in preeclampsia and the possibility of its treatment with AT III concentrate. Asia Oceania J Obstet Gynaecol 1989; 15: 25-32.
- 25 Trambert JJ, Einstein MH, Banks E. et al. Uterine artery embolization in the management of vaginal bleeding from cervical pregnancy: a case series. J Reprod Med 2005; 50: 844-850.
- 26 Van Wijk MJ, Boer K, Berckmans RJ. et al. Enhanced coagulation activation in preeclampsia: the role of APC resistance, microparticles and other plasma constituents. Thromb Haemost 2002; 88: 415-420.
- 27 Warkus T, Denys A, Hohlfeld P. et al. Management of postpartum haemorrhage. Rev Med Suisse 2005; 1: 2600-2604.