Literature Reviews
doi: 10.25005/2074-0581-2020-22-1-120-126
FEATURES OF DIAGNOSIS AND TREATMENT OF OBSTETRIC BLEEDING, ACCOMPANIED BY COAGULOPATHY

M.Ya. Kamilova, N.Z. Aminzoda

Tajik Scientific Research Institute of Obstetrics, Gynecology and Perinatology, Dushanbe, Republic of Tajikistan

The literature of recent years on modern methods of diagnosing and treating coagulation disorders in obstetric bleeding (OB) were studied and analyzed. The literature is presented on the frequency and structure of OB in the world and countries with different levels of development. It has been shown that massive OB is often accompanied by impaired blood clotting and lead to maternal mortality. In the structure of causes of maternal mortality in the world, OB is in the leading position. A theoretical and critical analysis of the literature on modern methods of diagnosing and treating coagulation disorders in OB has shown that it is necessary to continue further research on optimization of diagnostics and individual approaches in infusion-transfusion therapy of women with massive OB. Optimization of the methods of diagnosis and treatment of OB will improve obstetric outcomes in this complication.

Keywords: Obstetric bleeding, maternal mortality, coagulopathy, diagnostics, treatment.

Download file:

References
  1. Say L, Chou D, Gemmill A, Tunçalp O, Moller AB, Daniels J, et al. Global causes of maternal death: a WHO systematic analysis. Lancet Glob Health. 2014;2(6):323-33. Available from: https://doi.org/10.1016/S2214- 109X(14)70227-X.
  2. Barkagan ZS, Momot AP. Sovremennye aspekty patogeneza, diagnostiki i terapii DVS-sindroma [A modern aspect of pathogenesis, diagnosis and therapy of DIC syndrome]. Vestnik gematologii. 2005;1(2):5-14.
  3. Surina MN, Marochko TYu. Akusherskie krovotecheniya kak osnovnaya prichina kriticheskikh sostoyaniy i materinskoy smertnosti [Obstetris hemorrhage as the main cause of critical conditions and maternal motality]. Fundamental’naya i klinicheskaya meditsina. 2016;1(3):81-7.
  4. Ostrovskaya IV. Tseli razvitiya tysyacheletiya. Chto sdelano? Chto dal’she? [Millenium development goals. What the statement made. What’s next]. Meditsinskaya sestra. 2013;3:7-11.
  5. Volkov VG, Granatovich NN, Guseva EN. Akusherskie krovotecheniya v strukture prichin materinskoy smertnosti [Obstetrics hemorrhage in the structure of causes of maternal mortality]. Akusherstvo, ginekologiya i reproduktsiya. 2017;11(1):31-5.
  6. Davlyatova GK, Kamilova MYa, Malikshoeva SA, Amin-zoda NZ. Struktura i chastota akusherskikh krovotecheniy v Tadzhikistane [Frequency and structure of obstetric bleeding in Tajikistan]. Vestnik poslediplomnogo obrazovaniya v sfere zdravookhraneniya. 2019;1:53-8.
  7. Belousova AA, Aryutin DG, Toniyan KA, Dukhin A.O. Pozdnie poslerodovye krovotecheniya: aktual’nost’ problemy i puti eyo resheniya [Later postpartum haemorrhage:the urgency of problem and that solution]. Akusherstvo i ginekologiya. 2018;3:119-26.
  8. Davlyatova GK, Kamilova MYa, Ishan-Khodzhaeva FR. Sistematizatsiya prichin upushchennykh vozmozhnostey razvitiya kriticheskikh situatsiy pri akusherskikh krovotecheniyakh i preeklampsii [Systematization of obstetric bleeding and preeclampsia «near-miss» opportunity reason]. Zhurnal akusherstva i zhenskikh bolezney. 2018;67(2):26-31.
  9. Rossi AC, Mullin P, Gouez LE, Mercier FJ. The etiology of maternal mortality in developed countries: a systematic review of literature. Arch Gynecol Obstet. 2012;285:1499-503.
  10. Basaranoğlu S, Evsen MS, Ağaçayak E, et al. Evaluation of obstetrical patients with disseminated intravascular coagulapathy. Tertiary center experience. J Matern Fetal Neonatal Med. 2015;29:1-20.
  11. Erez O, Mastrolia SA, Thachil J. Disseminated intravascular coagulation in pregnancy: insights in pathophysiology, diagnosis and management. Am J Obstet Gynecol. 2015;213(4):452-63.
  12. Allard S, Green L, Hunt BJ. How we manage the haematological aspects of major obstretric haemorrhage. Haematol. 2014;164(2):177-88.
  13. Yamaura K. Perioperative management of blood coagulation – monitoring of coagulation disorder and fibrinolysis. Fukuoka Igaku Zasshi. 2014;105(3):67- 73.
  14. Yusupbaev RB. Akusherskie krovotecheniya: novye podkhody k operativnoy taktike [Obstetrics bleedings: the new approaches of operative tactics]. Meditsinskiy vestnik Bashkortostana. 2015;10(5):85-8.
  15. Kulakov AV, Shifman EM. Anesteziya, intensivnaya terapiya i reanimatsiya v akusherstve i ginekologii. Klinicheskie rekomendatsii [Anesthesia, intensive therapy and resuscitation in obstetrics and gynecology. Clinical protocols]. Moscow, RF: Meditsina; 2016. 472 p.
  16. Fowler A, Perry DJ. Laboratory monitoring of haemostatis. Anaesthesia. 2015;70(Suppl.1):68-72.
  17. Levi M. Diagnosis and treatment of disseminated intravascular coagulation. Int J Lab Hematol. 2014;36(3):228-36.
  18. Fomina IV, Kukarskaya II, Shevlyukova TP, Legalova TV. Tromboelastometriya v akusherskom statsionare [Thromboelastometry in obstetric hospital]. Sovremennye problemy nauki i obrazovaniya. 2017;4:59.
  19. Lunde J, Stensballe J, Wikkels A, Johansen M, Afshari A. Fibrinogen concentrate for bleeding – a systematic review. Acta Anaesthesiol Scand. 2014;58(9):1061-74.
  20. Hunt BJ. A practical guideline for the haematological management of major haemorrhage. Br J Haematol. 2015;170(6):788-803.
  21. Kamilova MYa, Davlyatova GK, Rozikova NM, Ishan-Khodzhaeva FR, Rakhmatullaeva DM. Rezervy uluchsheniya kachestva pomoshchi materyam s poslerodovymi krovotecheniyami [The reserves of improvement aid to mothers with postpartum bleedings]. Sciences of Europe. 2017;11(11):65-8.
  22. Krot IF, Zakharenkova TN, Eynysh EN. Sovremennye podkhody k profilaktike i lecheniyu akusherskikh krovotecheniy [The modern approaches in prophylaxis and treatment of obstetrics bleedings]. Problemy zdorov’ya i ekologii. 2013;2(2):93-7.
  23. Zaynulina MS, Eremeeva MI, Krivonos DR. Materinskaya smertnost’ i “near miss”: rabotayut li algoritmy profilaktiki krovotecheniy? [Maternal death and “near miss”: whether bleeding prevention algorithms works?]. Akusherstvo, ginekologiya i reproduktsiya. 2018;12(1):62-73.
  24. Logutova LS, An AV. Sovremennye podkhody k okazaniyu akusherskoy pomoshchi s tsel’yu snizheniya materinskoy i perinatal’noy zabolevaemosti i smertnosti [Modern approach in obstetric care for the reduce maternal and perinatal morbidity and death]. Rossiyskiy vestnik akushera-ginekologa. 2012;6:4.
  25. Sedinkin VA, Kligunenko EN. Obzor rekomendatsiy po intensivnoy terapii ostrykh massivnykh krovotecheniy v akusherstve [Review of recommendations on the intensive care for acute massive hemorrhage in obstetrics]. Meditsina neotlozhnykh sostoyaniy. 2017;5:48-60.
  26. Shifman EM, Kulikov AV, Belomestnov SR, Zabolotskikh IB. Intensivnaya terapiya i anesteziya pri krovopotere v akusherstve [Intensive care and anesthesia for blood loss in obstetrics]. Tol’yattinskiy meditsinskiy konsilium. 2013;1-2:19-36.
  27. Vymazal T. Massive hemorrhage management – a best evidence topic report. Ther Clin Risk Manag. 2015;11:1107-11.
  28. Kulikov AV, Shifman EM, Bulanov AYu, Zabolotskikh IB, Sinkov SV. Intensivnaya terapiya ostrykh narusheniy gemostaza v akusherstve (DVS-sindrom) [Intensive therapy of acute hemostasis disorders in obstetrics]. Anesteziologiya i reanimatologiya. 2017;62(5):399-406.
  29. Artymuk NV, Astakhov AA, Belokrinitskaya TE, Bulanov AYu, Zabolotskikh IB, Kulikov AV, i dr. Intensivnaya terapiya sindroma disseminirovannogo vnutrisosudistogo svyortyvaniya krovi (DVS-sindrom, koagulopatiya) v akusherstve [Intensive therapy of disseminated intravascular coagulation (DIS-syndrome, coagulopathy) in obstetrics]. Anesteziologiya i reanimatologiya. 2019;2:5- 26.
  30. Pacheco LD, Saade GR, Gei AF, Hankins GDV. Cutting edge advances in the medical management of obstetrical hemorrhage. Am J Obstet Gynecol. 2011;205:526-32.
  31. Hubinont C. Is fetomaternal hemorrhage still a major obstetric complication despite new technologies management. BJOA. 2016;123(12):1907.
  32. Le Gouez A, Mercier FJ. Major obstetric hemorrhage. Transfus Clinic Biol. 2016;23(4):229-32.
  33. Benhamou D. Plasma transfusion: Products and Indications. 2012 Guidelines Update. Biol. 2012;19(4-5):253-62.
  34. Butwick AJ, Goodnough LT. Transfusion and coagulation management in major obstetric hemorrhage. Curr Opin Anaesthesiol. 2015;28(3):275-84.
  35. Glotov MA, Birkun AA, Ryabikina EV, Samarin SA, Fedosov MI. Differentsirovannoe naznachenie gemostaticheskikh sredstv pri ostroy massivnoy krovopotere [Differentiated use of hemostatic agents in acute massive blood loss]. Tromboz, gemostaz i reologiya. 2017;2:13-8.
  36. Ryazanova OV, Aleksandrovich YuS, Shifman EM, Pshenisnov KV, Reznik VA. Sovremennye aspekty terapii matochnykh krovotecheniy pri predle-zhanii platsenty [Modern aspects of the treatment of uterine bleeding with placenta previa]. Pediatr. 2016;7(3):117-27.
  37. Shakur H, Roberts I, Fawole B, Chaudhri R, El-Sheikh M, Akintan A, et al. Effect of early tranexamic acid administration on mortality, hysterectomy, and other morbidities in women with post-partum haemorrhage (WOMAN): an international, randomised, double-blind, placebo-controlled trial. Lancet. 2017;389(10084):2105-16.
  38. Barinov SV, Lukach VN, Blauman SI, Krasnikova EP, Esipovich TV, Sabitova RSh. Intensivnaya terapiya rodil’nits, perenyosshikh tyazhelye oslozhneniya beremennosti [Intensive therapy of women in childbirth with severe complication of pregnancy]. Omskiy nauchnyy vestnik. 2013;1:153-6.
  39. Kulikov AV, Shifman EM. (red.) Anesteziya, intensivnaya terapiya i reanimatsiya v akusherstve i ginekologii [Anesthesia, intensive therapy and resuscitation in obstetrics and gynecology]. Moscow, RF: Meditsina: 2017. 688 p.
  40. Pacheco LD, Saade GR, Costantine MM, Clark SL, Hankins GD. An update on the use of massive transfusion protocols in obstetrics. Am J Obstet Gynecol. 2016;214(3):340-4.
  41. Zaynulina MS, Kornyushina EA, Krivonos MI. Strategiya preodoleniya materinskoy smertnosti, obuslovlennoy krovotecheniem [Strategy for overcoming maternal mortality due to bleeding]. Zhurnal akusherstva i zhenskikh bolezney. 2015;64(2):33-41.

Authors' information:

Kamilova Markhabo Yadgarovna
Doctor of Medical Sciences, Associate Professor, Head of the Obstetrics Department, Scientific Research Institute of Obstetrics, Gynecology and Perinatology
Scopus ID: 6507463534
ORCID ID: 0000-0002-2525-8273
Author ID: 867673
SPIN: 2527-2877
E-mail: marhabo1958@mail.ru

Aminzoda Nodira Zokirdzhon
Postgraduate Student, Obstetrics Department, Scientific Research Institute of Obstetrics, Gynecology and Perinatology
ORCID ID: 0000-0002-2525-8273
E-mail: marhabo1958@mail.r

Information about support in the form of grants, equipment, medications

The work was carried out according to the plan of scientific research works of Scientific Research Institute of Obstetrics, Gynecology and Perinatology (state registration number – 0119TJ00997). The authors did not receive financial support from manufacturers of medicines and medical equipment

Conflicts of interest: No conflict

Address for correspondence:

Kamilova Markhabo Yadgarovna
Doctor of Medical Sciences, Associate Professor, Head of the Obstetrics Department, Scientific Research Institute of Obstetrics, Gynecology and Perinatology

734002, Republic of Tajikistan, Dushanbe, Tursunzade str., 31

Tel.: +992 (935) 009425

E-mail: marhabo1958@mail.ru

◄ Back to the list