Obstetrik hastalarda dissemine intravasküler koagulasyon: maternal ve fetal sonuçları

Yıl 2023, , 1753 - 1758, 03.07.2023

Özgün Ceylan , Ali Çağlar

https://doi.org/10.38136/jgon.1179018

Öz

Amaç: Çalışmamızda obstetrik nedenlerle dissemine intravasküler koagulasyon (DİK) gelişen hastaların, antepartum değerlendirilmesi ile gelişebilecek komplikasyonların önceden önlenmesi ve maternal ve fetal morbidite ve mortalitenin azaltılması yönünde yol gösterici bilgilerin elde edilmesi amaçlanmıştır.
Gereçler ve Yöntem: Obstetri ve perinatoloji kliniklerine yatan ve DİK gelişen obstetrik hastalar retrospektif olarak incelendi. Hastaların DİK skorlaması International Society on Thrombosis and Haemostasis (ISTH) kriterlerine göre yapıldı. Hastaların maternal ve fetal sonuçları dökümante edildi.
Bulgular: Verilerin incelendiği 6 yıllık süre içerisinde 108281 doğumda 57 gebede DİK geliştiği tespit edildi ve DİK insidansı %0,052 olarak bulundu. DİK öncülü gebelik komplikasyonu kategorileri: plasenta invazyon ve implantasyon anomalileri, postpartum kanama (atoni), plasenta dekolmanı, gebeliğin hipertansif hastalığı ve diğer olarak bulundu. Maternal morbidte oranı %38.6, maternal mortalite oranı 1 hastayla %1.75 olarak bulundu. Hastaların %35’ine laparotomi/re-laparotomi ve bu hastalardan %21’ne histerektomi yapıldı. Yenidoğan doğum ağırlığı ortalaması 2341.3 gramdır. Yenidoğan yoğun bakım ihtiyacı %34.5, ölü doğum oranı %25,5’tir. Neonatal ölüm oranı %3,6 olarak tespit edilmiştir .
Sonuç: Doğumda yönetim şemasının anahtar bir rolü vardır çünkü gebeliğin terminasyonu genellikle altta yatan obstetrik bozukluğu ortadan kaldırır. Erken tanı ve aktif tedavi protokolleri, mortalite ve morbiditeyi azaltır. Gebelikteki koagulasyon kaskadında görülen fizyolojik değişikliklerden dolayı, gebe olmayan erişkinler için geliştirilen ISTH DİK skorlaması yerine gebeliğe spesifik bir DİK skorlamasının geliştirilmesi tanı koymayı kolaylaştırabilir.

Anahtar Kelimeler

Dik, postpartum kanama, obstetrik bozukluklar, skorlama sistemi, kan transfüzyonu

Disseminated intravascular coagulation in obstetric patients: maternal and fetal results

Öz

AIM: In our study, it was aimed to obtain guiding information to prevent complications that may develop in advance and to decrease maternal and fetal morbidity and mortality by evaluating the antepartum of patients who developed DIC due to obstetric reasons.
MATERIALS AND METHODS: Obstetric patients who were hospitalized in obstetrics and perinatology clinics and developed disseminated intravascular coagulation (DIC) were retrospectively analyzed. DIC scoring of the patients was made according to the International Society on Thrombosis and Haemostasis (ISTH) criteria. Maternal and fetal outcomes from the patients were documented.
RESULTS: During the 6-year period in which the data were analyzed, DIC was detected in 57 pregnants out of 108281 deliveries, and the incidence of DIC was found to be 0.052%. The categories of pregnancy complication preceding DIC: placental invasion and implantation anomalies, postpartum hemorrhage (atonia), placental abruption, hypertensive disease of pregnancy and others were found. Its rate in maternal morbidity was 38.6% and maternal mortality rate was 1.75% with 1 patient. 35% of the patients had laparotomy / re-laparotomy and 21% of these patients had hysterectomy. The average birth weight of the newborn is 2341.3 grams. Neonatal intensive care need is 34.5%, stillbirth rate is 25.5%. Neonatal mortality rate was determined as 3.6%.
CONCLUSION: The management scheme plays a key role in delivery because termination of pregnancy often eliminates the underlying obstetric disorder. Early diagnosis and active treatment protocols reduce mortality and morbidity. Because of the physiological changes seen in the coagulation cascade during pregnancy, using a pregnancy-specific DIC score instead of the ISTH DIC score developed for non-pregnant adults may facilitate diagnosis.

Anahtar Kelimeler

Dic, postpartum hemorrhage, obstetric disorder, scoring system, blood transfusion

Kaynakça

• 1. Levi M, ten Cate H. Disseminated Intravascular Coagulation. N Engl J Med. 19 Ağustos 1999;341(8):586-92.
• 2. Franchini M, Lippi G, Manzato F. Recent acquisitions in the pathophysiology, diagnosis and treatment of disseminated intravascular coagulation. Thrombosis J. 2006;4(1):4.
• 3. Berg CJ, Callaghan WM, Syverson C, Henderson Z. Pregnancy-Related Mortality in the United States, 1998 to 2005. Obstetrics & Gynecology. Aralık 2010;116(6):1302-9.
• 4. Østerud B, Bjørklid E. The Tissue Factor Pathway in Disseminated Intravascular Coagulation. Semin Thromb Hemost. 2001;27(06):605-18.
• 5. Lockwood CJ, Krikun G, Schatz F. Decidual Cell-Expressed Tissue Factor Maintains Hemostasis in Human Endometrium. Annals of the New York Academy of Sciences. Eylül 2001;943(1):77-88.
• 6. Taylor FB, Toh CH, Hoots WK, Wada H, Levi M, Scientific Subcommittee on Disseminated Intravascular Coagulation (DIC) of the International Society on Thrombosis and Haemostasis (ISTH). Towards definition, clinical and laboratory criteria, and a scoring system for disseminated intravascular coagulation. Thromb Haemost. Kasım 2001;86(5):1327-30.
• 7. Williams J, Mozurkewich E, Chilimigras J, Van De Ven C. Critical care in obstetrics: pregnancy-specific conditions. Best Practice & Research Clinical Obstetrics & Gynaecology. Ekim 2008;22(5):825-46.
• 8. Erez O. Disseminated intravascular coagulation in pregnancy – Clinical phenotypes and diagnostic scores. Thrombosis Research. Mart 2017;151:S56-60.
• 9. Rattray DD, O’Connell CM, Baskett TF. Acute Disseminated Intravascular Coagulation in Obstetrics: A Tertiary Centre Population Review (1980 to 2009). Journal of Obstetrics and Gynaecology Canada. Nisan 2012;34(4):341-7.
• 10. Callaghan WM, Creanga AA, Kuklina EV. Severe Maternal Morbidity Among Delivery and Postpartum Hospitalizations in the United States: Obstetrics & Gynecology. Kasım 2012;120(5):1029-36.
• 11. Erez O, Novack L, Beer-Weisel R, Dukler D, Press F, Zlotnik A, vd. DIC Score in Pregnant Women – A Population Based Modification of the International Society on Thrombosis and Hemostasis Score. ten Cate H, editör. PLoS ONE. 11 Nisan 2014;9(4):e93240.
• 12. Creanga AA, Berg CJ, Ko JY, Farr SL, Tong VT, Bruce FC, vd. Maternal Mortality and Morbidity in the United States: Where Are We Now? Journal of Women’s Health. Ocak 2014;23(1):3-9.
• 13. Francalanci I, Comeglio P, Liotta AA, Cellai AP, Fedi S, Parretti E, vd. D-dimer concentrations during normal pregnancy, as measured by ELISA. Thrombosis Research. Haziran 1995;78(5):399-405.
• 14. Bakhtiari K, Meijers JCM, de Jonge E, Levi M. Prospective validation of the International Society of Thrombosis and Haemostasis scoring system for disseminated intravascular coagulation*: Critical Care Medicine. Aralık 2004;32(12):2416-21.
• 15. Ryu JM, Choi YS, Bae JY. Bleeding control using intrauterine continuous running suture during cesarean section in pregnant women with placenta previa. Arch Gynecol Obstet. Ocak 2019;299(1):135-9.
• 16. Anderson-Bagga FM, Sze A. Placenta Previa. Içinde: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 [a.yer 28 Mart 2022]. Erişim adresi: http://www.ncbi.nlm.nih.gov/books/NBK539818/
• 17. Goksever Celik H, Celik E, Ozdemir I, Ozge Savkli A, Sanli K, Gorgen H. Is blood transfusion necessary in all patients with disseminated intravascular coagulation associated postpartum hemorrhage? The Journal of Maternal-Fetal & Neonatal Medicine. 19 Mart 2019;32(6):1004-8.
• 18. Malone DL, Hess JR, Fingerhut A. Massive transfusion practices around the globe and a suggestion for a common massive transfusion protocol. J Trauma. Haziran 2006;60(6 Suppl):S91-96.
• 19. Zhao Z, Zhang J, Li N, Yao G, Zhao Y, Li S, vd. Disseminated intravascular coagulation associated organ failure in obstetric patients admitted to intensive care units: a multicenter study in China. Sci Rep. Aralık 2021;11(1):16379.
• 20. Zhao Z, Han S, Yao G, Li S, Li W, Zhao Y, vd. Pregnancy-Related ICU Admissions From 2008 to 2016 in China: A First Multicenter Report. Critical Care Medicine. Ekim 2018;46(10):e1002-9.
• 21. Saintrain SV, Oliveira JGR de, Saintrain MV de L, Bruno ZV, Borges JLN, Daher EDF, vd. Factors associated with maternal death in an intensive care unit. Revista Brasileira de Terapia Intensiva [Internet]. 2016 [a.yer 06 Nisan 2022];28(4). Erişim adresi: http://www.gnresearch.org/doi/10.5935/0103-507X.20160073
• 22. Kurosawa S, Stearns-Kurosawa DJ. Complement, thrombotic microangiopathy and disseminated intravascular coagulation. j intensive care. Aralık 2014;2(1):61.
• 23. Nishida K, Sairenchi T, Uchiyama K, Haruyama Y, Watanabe M, Hamada H, vd. Poor uterine contractility and postpartum hemorrhage among low-risk women: A case-control study of a large-scale database from Japan. Int J Gynaecol Obstet. Temmuz 2021;154(1):17-23.