Журнал «Медицина неотложных состояний» 1 (64) 2015

Abstract: Much attention now is paid to treatment of disseminated intravascular coagulation, which is developing as result of massive obstetrics hemorrhage. There are many new hemostatic drugs, such as recombined factor VIIa, tranexamic acid or concentrate of prothrombin complex, which are used in case of massive obstetrics bleeding. New approach in intensive care of coagulation disorder is using of cryoprecipitate or fibrinogen concentrate as fibrinogen donator. It`s using is indicated in case decreasing of fibrinogen level less than 2 g/l.

Methods: We have made a retrospective study of labor histories of 129 pregnant women with cesarean section and different blood loss. Women, which had hard diseases (congenital heart defects, bronchial asthma, rheumatism, coagulation disorder, thrombocytopenia, preeclampsia, renal failure or liver failure) did not include in our study. It was compared the blood loss, the levels of hemoglobin, red blood cells, protein, fibrinogen, blood pressure, urine output in depend of replacement fluid therapy, which was given.

Results: All women were shared on the three groups in according to volume of blood loss. The first group consist of 53 women whose blood loss was less than 1% of body weight. It were women with cesarean section without any complications. The blood loss was replaced with normal saline (n=31) or with normal saline and colloids such as hetastarch 130/0.4 or 200/0.5 or modified gelatin (n=22). The second group consist of 49 women, which have placental abruption, placenta previa, uterine atony, myomectomy. Blood loss in it, was estimated between 1% and 2% of body weight. The blood loss was replaced with normal saline, fresh frozen plasma and red blood cells (n=24) or with normal saline, colloids, fresh frozen plasma and red blood cells (n=25). The third group consist of 27 women with blood loss over than 2% of body weight. There were women with placental abruption, placenta previa, placenta percreta, uterine atony and massive blood loss. In four cases the recombinant factor VIIa was given. There are no use of cryoprecipitate or concentrate of fibrinogen in any case. The blood loss was replaced with normal saline, colloids, fresh frozen plasma, and red blood cells. Levels of fibrinogen were compared in first day of hospitalization and on the first day after bleeding. The level of fibrinogen in pregnant women in term (the first group) was 6.53±0.27 g/l. The level of fibrinogen in women with blood loss less than 1% of body weight on the first day after cesarean section is 5.67±0.27. The level of fibrinogen in women with blood loss estimated between 1% and 2% of body weight on the first day after bleeding is 5.56±0.35 g/l, if fresh frozen plasma was given in dose 3.5-4.7 ml/kg. The level of fibrinogen in women which blood loss were more than 2% of body weight was 4.75±0.48 g/l, if fresh frozen was given in dose 14.6 ml/kg. In one case, only we have found indications to use the cryoprecipitate or fibrinogen concentrate.

Summary: The level of fibrinogen in pregnant women in term is 6.53±0.27 g/l. In most cases, fresh frozen plasma gives adequate level of fibrinogen during the bleeding or proper hemostasis. There are no necessary of routine use of cryoprecipitate or fibrinogen concentrate in case of obstetrics massive haemorrage.