• Gestational coagulopathy: breakthrough in views on bleeding prophylaxis

Gestational coagulopathy: breakthrough in views on bleeding prophylaxis

PERINATOLOGY AND PEDIATRIC. UKRAINE. 2017.3(71):39-43; doi 10.15574/PP.2017.71.39

Makarenko M. V., Hovsieiev D. О., Sokol  I. V., Slobodeniuk A. I., Berestovyi V. O., Vorona R. M.
Bogomolets National Medical University, Kyiv, Ukraine

Gestational thrombocytopaenia is the second haematological abnormality after anaemia, which occurs across pregnancy, and affects 7–10% of all pregnant women. Gestational thrombocytopaenia amounts approximately to 75% of all thrombocytopaenias across pregnancy and mostly tends to have benign course and does not cause unfavourable consequences for woman and her child.
Objective — to study the haemostatic system status in women with low platelet counts based on the thromboelastogram data.
Patients and methods. On the basis of Kyiv Municipal Maternity Hospital No. 5, an analysis of the labour and delivery medical records of women in the third trimester of pregnancy with platelets less than 150×109/L was carried out. Thromboelastography (TEG) was performed as an additional screening in all pregnants. Based on its results, the haemostatic system changes were found in 91 women, who comprised the main group and were randomly divided into two subgroups. The first subgroup included 48 pregnant women, who underwent transfusion of blood components. The subgroup II comprised 43 women, who had not been corrected haemostasis. The control group amounted to 44 women without pathological changes of TEG, having platelets level more than 150×109/L.
Results. While comparing blood loss during physiological delivery and caesarean section in subgroup I, II and control group, the significantly lower extent of blood loss was detected in the subgroup I compared to the subgroup II (p<0.05). The smallest extent of blood loss was observed in the control group compared with the main group (p<0.05).
Conclusions. The study showed the importance of TEG in preventing bleeding in pregnant women with low platelet counts. In general, TAG can demonstrate an integral haemostatic system status in vivo. Determining the haemostatic system parameters is of paramount importance in cases with expected «mandatory» intrapartum hemorrhage, or intraoperative bleeding, etc. An accurate management of haemostatic changes on the basis of TEG data helps prevent the massive bleeding.
Key words: thromboelastography, obstetric bleeding, thrombocytopaenia.


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