DOI: https://doi.org/10.22141/2224-0586.6.93.2018.147641

The role and place of exogenous coagulation factors in obstetric hemorrhages

V.A. Sedinkin, O.M. Klygunenko

Abstract


The work discusses the actual place and prospects of applying haemostatic drugs — factor concentrates — in intensive care of patients with massive obstetric hemorrhage. Acute massive obstetric hemorrhage remains one of the main causes of the multiple organ dysfunction syndrome in the peripartum period, which leads to a significant increase in 42-day mortality and duration of hospitalization in the intensive care unit. The central place in the pathogenesis of this condition belongs to coagulation disorders and dilutional coagulopathy. Control over coagulopathy in obstetric practice almost always depends on the use of plasma to achieve adequate hemostasis. However, large volumes of fresh frozen plasma contribute to volume overload and cardiac function impairment, and also expose the patient to an increased risk of red blood cell transfusion due to dilution. With the increased use of factor concentrates, patients can potentially have clotting factor reduction at higher concentrations in lower total transfusion volumes. The experience of using the prothrombin complex concentrate and recombinant activated clotting factor VII in obstetric practice is described. The use of exogenous coagulation factors for the prevention and treatment of coagulopathy with massive obstetric blood loss makes it possible to quickly restore the deficiency of procoagulant factors, maintain the balance between coagulation and anticoagulant systems and, as a result, to reduce the incidence and number of manifestations of multiple organ dysfunction syndrome, to increase patient’s survival, to minimize the risk of transfusion complications, to preserve the reproductive function.

Keywords


factor concentrates; obstetric hemorrhage; blood loss; coagulopathy; transfusion therapy; factor rVIIa; prothrombin complex concentrates; review

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