1/29. amniotic fluid embolism and isolated disseminated intravascular coagulation.PURPOSE: disseminated intravascular coagulation (DIC) is a well-known complication of an amniotic fluid embolus. However, clinical experience has shown that, in some patients, clinical hemorrhage may be the initial presentation. Mortality in this subset of patients is high. This report describes a patient with a suspected amniotic fluid embolus who survived and in whom the initial presentation was post partum hemorrhage. CLINICAL FEATURES: During the post delivery repair of a fourth degree perineal tear a 29 yr old prima gravida was noted to have excessive vaginal bleeding despite a well contracted uterus. Laboratory investigations revealed a decrease in hemoglobin from 126 g x l(-1) to 86 g x l(-1) and a severe disseminated intravascular coagulopathy (PT 27.5 sec, APPT 149 sec, direct fibrinogen < 0.6 g x l(-1), FDP > 640 g x l(-1)). Treatment included massive blood component therapy and, eventually, total abdominal hysterectomy. The patient subsequently recovered without sequelae. In the absence of any other explanation, the coagulopathy was considered to be secondary to amniotic fluid embolus. CONCLUSION: amniotic fluid embolus remains an important cause of maternal mortality. Clinical reports, reviews of the literature, and the development of the national registry have all contributed to our understanding of this syndrome. Contrary to earlier beliefs, not all patients present with sudden cardiorespiratory collapse. As the present case illustrates, a less common presentation is the development of an isolated DIC in the peripartum period without antecedent hemodynamic or respiratory instability. Therefore, anesthesiologists must maintain a high index of suspicion for the disorder in order to facilitate early recognition and treatment.- - - - - - - - - - ranking = 1keywords = intravascular coagulation, coagulopathy, coagulation, intravascular (Clic here for more details about this article) |
2/29. factor vii deficiency detected in pregnancy: a case report.factor vii deficiency is a rare hereditary coagulation disorder with an incidence estimated at 1 in 500,000 individuals. In this report, we describe the 13th case in pregnancy. The diagnosis of severe factor vii deficiency (factor VII level <5%) was established at 10 weeks' gestation after initial laboratory testing showed a markedly prolonged prothrombin time and a normal activated partial thromboplastin time. There was a history of two preterm deliveries, but there was no evidence of previous bleeding manifestations. Antenatal progress of the index pregnancy was unremarkable. Prophylactic treatment with fresh frozen plasma was started at the onset of labor and the patient had a vaginal delivery of a live girl at 36 weeks' gestation. There was no postpartum hemorrhage and mother and newborn were discharged in good condition. The patient's postpartum level of factor VII remained undetectable. Two aspects are outlined: the absence of any significant increase in factor VII clotting activity during this pregnancy and the need to give replacement therapy at labor in patients with severe factor VII deficiency to decrease the risk of postpartum hemorrhage.- - - - - - - - - - ranking = 0.019356406038664keywords = coagulation (Clic here for more details about this article) |
3/29. Precipitate delivery and postpartum hemorrhage after term induction with 200 micrograms misoprostol.misoprostol has been widely applied in early pregnancy termination and term pregnancy induction. However, the upper dosage limit of misoprostol through vaginal route has not been firmly established. Most popular dosages of vaginal misoprostol recommended are 25, 50 or 100 micrograms. There are no reports on the dangers of high-dosage misoprostol 200 micrograms as used in term labor induction. We present a primiparaous woman who was administered 200 micrograms misoprostol vaginally for term labor induction. The following precipitate delivery resulted in multiple lacerations of the isthmus, cervix and vagina, postpartum hemorrhage and disseminated intravascular coagulopathy. Inevitably, a hysterectomy was performed. A postsurgical check of the uterus confirmed lacerations of the isthmus and internal cervix. This rare complication suggests the possible dangers of vaginal misoprostol doses as high as 200 micrograms for term induction of labor at term.- - - - - - - - - - ranking = 0.099390622750572keywords = coagulopathy, intravascular (Clic here for more details about this article) |
4/29. Postpartum acquired hemophilia (factor viii inhibitors): a case report and review of the literature.Pathologic inhibitors of blood coagulation as a cause of postpartum acquired hemostatic failure are rare. Since 1937, 96 cases of postpartum factor viii (FVIII) inhibitors, including the current case, have been reported. Suspicion for the diagnosis of this condition is often low. We report a case of postpartum FVIII inhibitor formation in a 24-year-old woman who developed intermittent postpartum bleeding that resulted from the inhibitors she formed to FVIII. A unique form of therapy was used in treatment of her disorder. She did not respond to conventional surgical or medical management of her bleeding until Autoplex T (Baxter Healthcare, Glendale, CA), an activated prothrombin complex concentrate (aPCC) was used. The literature concerning acquired hemophilia is reviewed, and new therapeutic medical advances are emphasized.- - - - - - - - - - ranking = 0.019356406038664keywords = coagulation (Clic here for more details about this article) |
5/29. Laparoscopic bipolar coagulation of uterine vessels to manage delayed postpartum hemorrhage.postpartum hemorrhage (PPH) is a big challenge for obstetricians. fertility-preserving procedures are encouraged, especially in young women. Bilateral hypogastric (internal iliac) artery ligation, bilateral uterine artery ligation after vaginal delivery or after cesarean delivery, and uterine artery embolization are well documented vascular occlusive methods for treating PPH. To our knowledge, the laparoscopic approach to uterine artery ligation has not been reported. A 29-year-old woman experienced delayed PPH. Although curettage of the uterine cavity to remove retained placenta was performed, bleeding did not stop. We successfully performed a relatively new method--laparoscopic bipolar coagulation of uterine vessels--to stop bleeding and preserve the uterus.- - - - - - - - - - ranking = 0.09678203019332keywords = coagulation (Clic here for more details about this article) |
6/29. hyponatremia and hypoglycemia in acute Sheehan's syndrome.We report the case of a 23-year-old Saudi Arabian woman who presented to the medical intensive care unit with severe hyponatremia and hypoglycemia following a cesarean section delivery complicated by hemorrhage due to disseminated intravascular coagulopathy. She was treated successfully for adrenal insufficiency acutely, and was later discharged on hormone replacement therapy. To our knowledge, this is the first case report of acute Sheehan's syndrome presenting with both hyponatremia and suggestive hypoglycemia. Pituitary necrosis is an uncommon complication of peripartum hemorrhagic shock. Since the initial description by Sheehan in 1937, the incidence of the syndrome has gradually declined through improved management of hemodynamic complications leading to the infarction of the gland. There are many studies describing complications of late Sheehan's syndrome; however, relatively few contain descriptions of the acute phase. In addition, the diagnosis of this syndrome is often determined after resolution of the acute process with resultant lack of data regarding immediate endocrine and imaging abnormalities. In this report, we describe the complete endocrine and imaging assessment of a patient presenting in critical condition due to necrosis of the pituitary gland in the immediate postpartum period.- - - - - - - - - - ranking = 0.099390622750572keywords = coagulopathy, intravascular (Clic here for more details about this article) |
7/29. Use of recombinant factor viia to treat life-threatening non-surgical bleeding in a post-partum patient.Ongoing bleeding from patients who have an acquired coagulopathy post-surgery is a common problem. Strategies that are available to combat this problem revolve around the replacement of coagulation factors, platelets, and red blood cells as necessary. These strategies are not always successful and a more direct approach to activating the coagulation system can be more effective and in some instances life saving. We describe the use of recombinant factor viia in a patient with ongoing post partum bleeding.- - - - - - - - - - ranking = 0.12197096166333keywords = coagulopathy, coagulation (Clic here for more details about this article) |
8/29. Recombinant factor viia after amniotic fluid embolism and disseminated intravascular coagulopathy.This case report illustrates the successful use of activated recombinant factor viia in the management of severe postpartum hemorrhage secondary to amniotic fluid embolism.- - - - - - - - - - ranking = 0.39756249100229keywords = coagulopathy, intravascular (Clic here for more details about this article) |
9/29. Uterine cavity synechiae after hemostatic square suturing technique.BACKGROUND: A number of surgical techniques to control severe bleeding at cesarean delivery have been proposed, such as uterine artery ligation, hypogastric artery ligation, and uterine compression suturing. CASE: A primigravida with severe postpartum hemorrhage and disseminated intravascular coagulopathy had multiple square sutures placed through the uterus. Serial sonographic follow-up studies revealed uterine synechiae with partial obstruction of menstrual flow. hysteroscopy confirmed unabsorbed sutures in the uterine cavity. CONCLUSION: The use of multiple sutures through the uterus is effective to control postpartum hemorrhage but may lead to uterine synechiae.- - - - - - - - - - ranking = 0.099390622750572keywords = coagulopathy, intravascular (Clic here for more details about this article) |
10/29. Acute fatty liver of pregnancy complicated with disseminated intravascular coagulation and haemorrhage: a case report.Acute fatty liver of pregnancy (AFLP) is a rare disorder of unknown aetiology that is diagnosed typically in the third trimester or early postpartum period. The incidence is estimated to be 1/6692-1/13,328. The obstetric team must have a high index of suspicion of this pathology, particularly in the presence of clinical and laboratory findings, such as nausea, vomiting, jaundice, increased serum transaminase levels, increased prothrombin time and hypoglycaemia. early diagnosis followed by prompt delivery and supportive care provides significantly improved maternal and perinatal outcome. Delay in diagnosis of this obstetric emergency may lead to rapid progression to hepatic failure, disseminated intravascular coagulation (DIC), haemorrhage, encephalopathy, multiple organ failure and finally death. The case of a 34-year-old woman, gravida 3, para 2, with AFLP complicated with DIC is presented herein with a review of literature and discussion of its origin.- - - - - - - - - - ranking = 0.81735122766343keywords = intravascular coagulation, coagulation, intravascular (Clic here for more details about this article) |
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