妇产科的弥散性血管内凝血

弥散性血管内凝血在妇产科很早即引起人们的注意,而对其定名则有过长期的争论。1901年De-lee描述1例胎盘早期剥离称为“一时性血友病”之后,有人将其归入“无纤维蛋白原血症”或“低纤维蛋白原血症”;而另外一些人则坚持认为用“纤维蛋白缺少症”或“纤维蛋白增多综合症”才能明确说明这一障碍。随着试验技术的不断提高及在病理生理方面了解的深入,现在主张用“消耗性凝血病”及“弥散性血管内凝血”这两个名词。弥散性血管内凝血(简称DIC)的病理特点是促凝物质进入血循环内而广泛发生血小板集聚及纤维蛋白沉积从而形成弥散性微血栓,因此,血小板及凝     

30卷1期疑难病案讨论选登

<正>韩英杰,张霞,张文秀(山东省济宁市第一人民医院,山东济宁272000)1诊断①弥散性血管内凝血;②晚期产后出血;③失血性贫血;④KT综合征;⑤盆腔静脉出血:盆腔静脉瘤破裂?2诊断依据及分析2.1弥散性血管内凝血患者大量出血病史,且凝血功能检查PT、APTT均延长,纤维蛋白原降低,D-二聚体两次不凝。结合患者盆腔大量出血病史,均支持该诊断。     

产科急性弥散性血管内凝血11例分析

产科急性弥散性血管内凝血１１例分析北京同仁医院（１００７３０）妇产科张秀荣纪克宁血液科刘复强产科弥散性血管内凝血（ＤＩＣ）病情进展迅速，临床凶险，治疗棘手，母婴病死率已跃居孕产妇死亡之首。［１］如何做到早期诊断，把握时机正确治疗是抢救ＤＩＣ的关键。本...     

产科急性弥散性血管内凝血临床分析

目的：探讨产科急性弥散性血管内凝血的临床诊治。方法：回顾我院2005年2月—2011年9月我院收治的产科急性弥散性血管内凝血患者20例,给予治疗原发病、吸氧、抗休克、扩容、纠正酸中毒、纠正水和电解质的失衡、肝素治疗、补充血液和凝血因子。结果：2例患者子宫切除,7例患者行急诊剖宫产,11例患者给予肝素治疗,治愈19例（95.0%）,死亡1例（5.0%）,由于重症妊娠高血压综合症,抢救时发生严重肾衰竭抢救无效死亡,围生儿死亡1例。患者住院7～25 d,平均13 d。结论：产科急性弥散性血管内凝血是严重的产科合并症,及早诊断、治疗能提高治愈率,降低死亡率。     

580例稽留流产患者处理方式及结局的分析

稽留流产指胚胎或胎儿在宫内死亡后未及时自然排出,属流产范畴.由于胚胎死亡,妊娠组织在官腔内稽留时间较长,可能造成凝血功能障碍,甚至导致弥散性血管内凝血(DIC),引起大量出血.     

加强对羊水栓塞的认识提高诊断及治疗质量

羊水栓塞是指羊水进入母体血循环，导致过敏性休克，肺血管痉挛及栓塞，弥散性血管内凝血，肾功能衰竭甚至猝死的严重分娩并发症。以起病急骤，病情凶险、难以预料，病死率高为其临床特点。     

产科DIC合并急性肾功能衰竭的治疗

弥散性血管内凝血(DIC)是许多疾病中一个严重复杂的病理过程。诱发因素很多,其中以产科并发症(羊水栓寒、胎盘早期剥离、前置胎盘、重度妊娠高血压综合征。产后流血及产后感染等)引起者最常见。病情急骤、发展迅速。其典型的病理改变是毛细血管内纤维蛋白的沉积、微血栓形成,组织局灶性出血及梗死性坏死。由于DIC对肾脏损伤严重,可引起肾微血管阻塞,肾小管缺血、缺氧,甚至肾皮质急性坏死,因此如不及时治疗极易导致急性肾功能衰竭(简称肾     

肿瘤及瘤样病变

CXCR4在儿童急性白血病的表达及临床意义;儿童急性白血病WTI基因表达的临床意义;低分子量肝素对儿童急性白血病DIC早期干预研究;姐妹染色单体交换在小儿急性白血病诊断中的应用;急性自血病并弥散性血管内凝血患儿凝血与纤溶功能变化的意义.     

产科弥漫性血管内凝血28例临床分析

目的：探讨产科弥漫性血管内凝血的诊断和治疗方法。方法：采用回顾性分析方法对2006年1月1日～2011年9月31日在河南省汝州市第一人民医院妇产科住院治疗的28例产科弥散性血管内凝血患者的临床资料进行整理和分析。结果：25例抢救成功,死亡3例,其中重度妊高征伴胎盘早剥1例。结论：早期正确诊断,及时采取应对措施,对病因进行消除,合理使用肝素,进行血液替代治疗是保障产科弥漫性血管内凝血抢救成功的关键措施。     

妊高征与弥散性血管内凝血

妊高征与弥散性血管内凝血中国医科大学第二临床学院（１１０００３）王德智妊高征的病因迄今尚不清楚，有多种理论诸如内分泌失调学说、免疫学说、水钠潴留学说、营养失调学说、子宫缺血学说、血管内皮损伤学说及血凝障碍学说等，可谓众说纷纭，尚无一种学说能完整地阐明...     

The Role of Enzymes in Disseminated Intravascular Coagulation: An Overview

The enzymatic mechanisms of blood coagulation and fibrinolysis day an important role in the crisis of disseminated intravascular coagulation. They tend to protect the organism against death from extensive intravascular thrombosis, but in the process they produce a serious hemorrhagic state that could lead to exsanguination. Heparin inhibits clotting and minimizes fibrinolysis, thereby allowing the gradual natural restoration of decreased blood coagulation factors and subsequent hemostasis. The survival of the patient, in the meantime, will depend on the successful treatment of the hypovolemic shock Resent and on preventing further passage into the circulation of thromboplastic material which triggers intravascular clotting.     

Predictive factors related to the efficacy of pelvic arterial embolization for postpartum hemorrhage: A retrospective analysis of 21 cases

ObjectiveThis retrospective study aimed to determine the predictive factors for the efficacy of pelvic arterial embolization for postpartum hemorrhage.Materials and methodsTwenty-one patients who underwent pelvic arterial embolization for postpartum hemorrhage of >1000 mL between September 2006 and September 2011 were enrolled in this study. The patients were divided into two subgroups according to the blood loss and time from the end of pelvic arterial embolization to complete hemostasis: good-response (16 patients) and poor-response groups (5 patients). The following predictive factors were compared between the groups: (1) patient characteristics; (2) blood loss; (3) time between delivery (or onset of bleeding) and pelvic arterial embolization; (4) obstetrical disseminated intravascular coagulation score comprising clinical background, clinical signs, and laboratory data; (5) individual disseminated intravascular coagulation score; (6) shock index; and (7) laboratory data including platelet count, prothrombin time-international normalized ratio, fibrinogen, fibrin degradation products, and antithrombin-III at the time of pelvic arterial embolization.ResultsIn the poor-response group, the obstetrical and individual disseminated intravascular coagulation scores and prothrombin time-international normalized ratio were higher than those in the good-response group (p < 0.05). Platelet count, fibrinogen, and fibrin degradation products were lower than those in the good-response group (p < 0.05). All obstetrical disseminated intravascular coagulation scores in the poor-response group were >9 points.ConclusionThe efficacy of pelvic arterial embolization is related to the presence or absence of coagulation disorders. When the obstetrical disseminated intravascular coagulation score is high (>9 points), the efficacy may be poor.     

Twin pregnancy with intrauterine death of one twin

The antepartum death of one twin is a rare obstetric complication. Two cases are presented, accompanied by a review of the current literature. The premature and neonatal death rates are high in the surviving twins. Toxemia, fetal distress, abnormal presentation, and dystocia are also increased. Maternal disseminated intravascular coagulation has been demonstrated without a concomitant fetal coagulation defect. A more unique finding is fetal disseminated intravascular coagulation with a monochorionic placenta. The common circulation between the live and dead twins may result in fetal cerebral, renal, and cutaneous lesions, usually without demonstrable maternal disease. High-risk obstetric management is reviewed and a careful pediatric follow-up is recommended with monozygotic twins.     

Acute renal failure induced by disseminated intravascular coagulopathy in a patient with adenomyosis

Disseminated intravascular coagulation is most frequently associated with obstetric catastrophes, metastatic malignancy, massive trauma and bacterial sepsis, but relatively rarely related to benign tumors. We report on disseminated intravascular coagulopathy in a patient with significant adenomyosis and menometrorrhagia. An extremely rare case, disseminated intravascular coagulopathy developed in this benign case and was successfully treated with a hysterectomy and blood product transfusions.     

Combination estrogen and progestogen replacement therapy does not adversely affect coagulation

Coagulation and fibrinolysis profiles of naturally menopausal women receiving conjugated estrogens (0.625 or 1.25 mg for 21 of 28 days) and medroxyprogesterone acetate (10 mg for seven of 28 days) for 18 months were compared with those of similar women receiving no hormone therapy. Tests indicative of the dynamics of the coagulation cascade, ongoing intravascular coagulation, and anticoagulation were performed. Hormone therapy had no effect on prothrombin times, activated partial thromboplastin times, or thrombin times. There was no evidence of intravascular coagulation in any of the groups as assessed by platelet counts, fibrinogen antigen and activity, and fibrin degradation products. Antithrombin III antigen and activity, alpha 1-antitrypsin antigen, and alpha 2-macroglobulin antigen, the natural inhibitors of coagulation, were also unaffected by hormone therapy. Plasminogen antigen levels were unaffected, but plasminogen activity was enhanced in the hormone-treated groups, suggesting a stimulatory effect on fibrinolysis. These data indicate that in terms of the coagulation system, healthy women can safely use a combined regimen of conjugated estrogens and medroxyprogesterone acetate.     

Postabortal haemorrhage and disseminated intravascular coagulation due to placenta accreta

We describe the case of a second trimester placenta accreta presenting as postabortal haemorrhage complicated by disseminated intravascular coagulation, requiring hysterectomy.     

Leberpathologie im rahmen des HELLP-syndroms

Liver pathology is one of the main features of HELLP syndrome and develops on the basis of a generalised activation of intravascular coagulation. Fibrin deposits and haemorrhagic necrosis predominantly develop in the periportal areas and may eventually lead to subcapsular haematomas or even rupture of the liver. While the compensated form of activation of intravascular coagulation, which is diagnosed by a decrease in antithrombin III and an increase in thrombinantithrombin III complex (TAT) and the appearance of fibrin, monomers andd-dimers, is found in almost all cases of HELLP syndrome, the decompensated form of intravascular coagulation with prolonged bleeding time (PT, PTT) and drop in fibrinogen is found only in the most severe forms. The development of a decompensation of coagulation correlates with the appearance of severe complications such as liver haematoma, abruptio placentae, renal failure and pulmonary oedema. The best prophylaxis against the development of life-threatening complications is early diagnosis and termination of pregnancy after stabilisation of the maternal condition, consisting of magnesium sulphate infusion, antihypertensive treatment with dihydralazin or calcium antagonists, steroids etc. Severe complications of HELLP syndrome have occasionally been observed in the postpartum period. As prophylaxis against postpartal worsening of HELLP syndrome, curettage of the uterus and continuation of the treatment with calcium antagonists and dexamethasone have been recommended.     

Intravascular coagulation in relation to pregnancy and delivery

Incidence, risk factors and morphological features of the intravascular coagulation (IC) in 160 women who had died during pregnancy, after abortion and delivery were studied. IC was established in 118 (73.8%) of them. The main risk factors leading to IC were shock (59.3%), sepsis (28.8%), toxemia of pregnancy (incl. eclampsia) (25.4%), Caesarean section (19.5%), fetal death in utero (12.7%), amniotic fluid embolism (9.3%), and abruptio placentae (7.6%). Disseminated intravascular coagulation (DIC) was established in 66% of the cases, and local intravascular coagulation (univisceral localisation of microthrombi) in 28%. In the resting 6% of the cases there was consumptive coagulopathy without microthrombi. Lungs, pituitary gland, uterus, kidneys and adrenals were the most frequently affected organs. Necrosis in the parenchymal organs, hyaline membrane formation in the lungs and consumptive coagulopathy were particularly frequent in the cases with DIC. The leading causes of death were acute renal failure and ARDS. It was established that prolonged intensive care including artificial ventilation, massive blood transfusion, as well as surgical treatment, aggravate the course and morphological features of IC.     

The obstetric patient and disseminated intravascular coagulation

Disseminated intravascular coagulation remains a major problem for the practicing obstetrician. The various etiologies, the pathophysiology, and suggested therapeutic regimens are reviewed.     

Maternal death associated with hydatidiform molar pregnancy

Three maternal deaths with hydatidiform molar pregnancies associated with severe hemorrhage and coagulopathy are described. Symptoms of coagulation abnormalities are few in mild degrees of intravascular coagulation. This paper addresses the importance of anticipating a coagulopathy in hydatidiform molar pregnancy even before evacuation of the abnormal conceptus since evacuation aggravates fibrinolytic activity and therefore increases hemorrhage in these conditions.