SU1346139A1 - Method of predicting massive hemorrhage in time of and after labor - Google Patents

Abstract

The invention is intended for obstetrics and gynecology. The purpose of the invention is early prediction. Hemostasis parameters are measured by thromboelastographic indices, by activated partial thromboplastin time and activated recalcification time. In the presence of an initial hypercoagula- tion, a test dose of hemodilution with heparin is administered. Then hemostasis parameters are measured again. By a change in the indicated indices towards isocoagulation, massive bleeding is predicted. At the same time, temporal parameters of plasma hemostasis are extended. Early diagnosis can prevent a fatal outcome. The prediction accuracy is on average 93%. 2 hp f-ly. (L SO

Description

five

This invention relates to medicine, namely obstetrics and gynecology.

The aim of the invention is early prediction.

The method is carried out as follows.

In a pregnant woman, hemostasis parameters are measured by thromboelastogram indices (R, K, and ITP), as well as Q by activated partial thromboplastin time (APTT) and activated recalcification time (AVR) | where R is the reaction time from the moment calcium chloride is added to the first fibrin filament, which is registered by the deviation of the needle of the recorder by 1 mm; It characterizes the time from the formation of the first filaments of fibrin to the formation of a fibrin clot of 2 ° of a certain standard density, which registers with a deviation of the instrument arrow by 20 mm; it characterizes the retractor properties of a blood clot (a value of 25 for this indicator corresponds to the maximum deviation of the selection arrow); ITP is the index of thrombodynamic potential, which is calculated by the formula30

ETC

Ema K

where K is a constant thromboelastogram :; that is the maximum amplitude of the throm-jg boelastogram;

Ema

100-ma 100-ma

AVR in the presence of kaolin characterizes the total activity of blood coagulation factors II, V, VIII., IX, X, XI and XII, which constitute the internal mechanism of blood coagulation under conditions of standard activation of contact factors.

The APTT test is carried out in the presence of kaolin and a phospholipid and makes it possible to estimate the total activity of blood coagulation factors constituting the internal coagulation mechanism under conditions of standard activation of contact factors and the standard content of phospholipids.

Upon detection of initial hypercoagulation, as well as taking into account individual sensitivity to heparin, the test dose is administered at a constant rate, depending on body weight.

solution of hemodilum-tanta with heparin of this pregnant. After 60 minutes from the end of the transcoding of the tecT-dose, hemostasis parameters are measured again. If the indicated parameters change after 60 minutes from the moment of administration of the test dose compared to the initial iso-coagulation, obstetric hemorrhage is predicted.

Example 1. Pregnant T., 26 years old, clinical diagnosis: pregnancy 39–40 weeks, headache, grade II nephropathy, varicose veins of the lower extremities. Before delivery, blood was taken from her to investigate the hemostasis system; the following data was obtained: thromboelastogram of whole blood: R 7 mm, K 6 mm, 60 mm, ITP 25, ABP 62 s, APTT 38 s.

The obtained indicators characterize structural and chronometric hypercoagulation, plasma hemostasis indicators within the normal range. The test dose in the form of a colloidal solution of reopolyglucine containing 75 units / kg of heparin body weight is transferred to the pregnant woman. After completion of the transfusion of the test dose at a rate of 0.4 ml / min / kg in the newly examined sample, 60 minutes after the end of its administration, the values of the hemostatic system parameters were obtained: R 8 mm, K 7 mm, 45 mm, ITP 11.7, ADB 86 s, APTT 52 s.

The obtained indicators characterize isocoagulation, lengthening of temporal parameters of plasma hemostasis, i.e. the proposed method in a pregnant woman predicts massive blood loss. The forecast was confirmed. After delivery through the birth canal, the mother gave birth to massive bleeding, to stop which the operation was performed - supravaginal amputation of the uterus, which led to the disability of the woman.

Example 2. Pregnant V., 32 years old, birth history number 906. Clinical diagnosis: pregnancy 37-38 weeks, headache, nephropathy III degree, first born at 32 years old. Provision for delivery by cesarean section. Before surgery, she was bled to investigate hemostatic system parameters. The following data was obtained:

313

thromboelastogram R 6 mm, K 5 mm, 55 mm, ITP 24.4, ABP 50 s, APTT 30 s, which characterize the chronometric) and structural typing-coagulation, shortening of the temporal parameters of plasma hemostasis. A patient during surgery is indicated for hemodynamic and heparin therapy. However, individual sensitivity to hemodilution solutions and heparin was taken into account. According to the proposed method, the patient is transfused with a test dose of a hemodilught in the form of Ringer's solution containing 75 units / kg of body weight of heparin. After completion of the transfusion of the test dose at a rate of 0.4 ml / min / kg, in the newly examined blood sample 60 minutes after the end of the administration, the values of the hemostatic system parameters were obtained: R 9 mm, K 10 mm, 46 mm, ITP 8.5 , ABP 80 s, APTTV 51 s. The obtained indicators characterize iso-coagulation, lengthening of the temporal parameters of plasma hemostasis. When caesarean section was performed, massive blood loss (1900 ml) occurred with the development of hemorrhagic shock. The forecast was confirmed.

Editor I. Nikolaichuk Order 5070/4

Compiled by L. Purysheva Tehred M. Dvdyk

Circulation 594

VNIIPI USSR State Committee. for inventions and discoveries 113035, Moscow, Zh-35, Raushsk nab., 4/5

Production and printing company, Uzhgorod, st. Draektna 4

39 Fort

Mula invented. eni

Claims (3)

1. A method for predicting massive bleeding during and after childbirth, characterized in that, for the purpose of its early prediction, hemostasis parameters are determined in a pregnant woman and the initial dose of hemodyutant with heparin is administered during initial hypercoagulation, hemostasis parameters are re-measured and when the hemostasis changes since the end of the transfusion of the test dose for the same period of time towards isocoagulation, massive obstetric bleeding is predicted. 2. A method according to claim 1, characterized in that a colloidal solution of reopolyglucine is administered as a test dose of hemodynamic fluid at the same rate. I 3. The method according to claim 1, wherein the hemostasis parameters are determined by the parameters of the thromboelastogram, as well as by the activated partial thromboplastin time and the activated time of recalcification. L. Purysheva ak Proofreader I. Muska Subscription