Abruptio placenta and adverse pregnancy outcome.

Hossain N, Khan N, Sultana SS, Khan N.

Department of Obstetrics & Gynecology Unit-3, Civil Hospital & Dow University of Health
Sciences,1-3 Karachi, Pakistan.

Abstract

OBJECTIVE: To determine the risk factors in pregnancies complicated with abruptio placenta

METHODS: Case-control study. The study was conducted at department of Obstetrics and
Gynecology Unit 3, Civil Hospital, Dow University of Health Sciences Karachi. The study
period was from January to December 2008. All pregnant women who were diagnosed with
abruptio placenta after 28 weeks of gestation were included in the study. They were compared
with women who had live birth during the study period. This group was taken as controls. Both
groups were identified from the admission, labour room registers.

RESULTS: Total number of deliveries during the study period was 2610. Patients identified with
abrupio placenta were 81, giving a frequency of 3.75%. Majority (44%) of women were between
26-30 years of age group. Forty three (54%) of the women were second, third or fourth gravida.
The mean gestational age was 34 +/- 4.21 weeks. Forty one (51%) delivered preterm before 37
weeks and 40 (49%) delivered at or after 37 completed weeks of gestation. Vaginal delivery was
the main mode of delivery, followed by Caesarean section. Vaginal bleeding was the most
common clinical finding seen in 80% (68/81) women, followed by blood stained amniotic fluid
in 45% (37/81). Foetal heart sounds were absent on admission in 65% (53/81). There were two
maternal deaths due to postpartum haemorrhage. The perinatal mortality rate was 66% (54/81).
Parity and gestational age were found to be significant risk factors for abruptio placentae (p <
0.031 and p < 0.001 respectively).

CONCLUSION: Abruptio placenta is associated with poor maternal and foetal outcomes.
Abruptio plasenta dan hasil kehamilan yang
merugikan
Hossain N, N Khan, SS Sultana, N. Khan

Bagian Obstetri & Ginekologi Unit-3, Rumah Sakit Sipil & Universitas Dow Ilmu Kesehatan ,1-
3 Karachi, Pakistan.

Abstrak
TUJUAN: Untuk menentukan faktor risiko pada kehamilan yang rumit dengan abruptio plasenta
METODE: Kasus-control study. Penelitian ini dilakukan di departemen Obstetri dan Ginekologi
Unit 3, Rumah Sakit Sipil, Dow University of Health Sciences Karachi. Periode penelitian
adalah dari bulan Januari sampai Desember 2008. Semua wanita hamil yang didiagnosis dengan
plasenta abruptio setelah 28 minggu kehamilan dilibatkan dalam penelitian. Mereka
dibandingkan dengan wanita yang telah kelahiran hidup selama masa studi. Kelompok ini
diambil sebagai kontrol. Kedua kelompok diidentifikasi dari tiket masuk, tenaga kerja register
kamar.
HASIL: Jumlah kelahiran selama masa studi adalah 2610. Pasien diidentifikasi dengan plasenta
abrupio adalah 81, memberikan frekuensi 3,75%. Mayoritas (44%) perempuan berusia antara 26-
30 tahun dari kelompok umur. Empat puluh tiga (54%) dari perempuan tersebut gravida kedua,
ketiga atau keempat. Usia kehamilan rata-rata adalah 34 + / - 4,21 minggu. Empat puluh satu
(51%) disampaikan prematur sebelum 37 minggu dan 40 (49%) yang disampaikan pada atau
setelah 37 minggu kehamilan selesai. pengiriman vagina adalah moda utama pengiriman, diikuti
dengan operasi caesar. Perdarahan pervaginam merupakan temuan klinis yang paling umum
terlihat pada 80% (68/81) perempuan, diikuti oleh cairan ketuban bernoda darah di 45% (37/81).
suara jantung janin tidak hadir pada masuk di 65% (53/81). Ada dua kematian ibu karena
perdarahan postpartum. Angka kematian perinatal adalah 66% (54/81). Paritas dan usia
kehamilan ditemukan sebagai faktor risiko yang signifikan untuk abruptio plasenta (p <0,031 dan
p <0.001 masing-masing).

KESIMPULAN: abruptio plasenta dikaitkan dengan hasil ibu dan janin miskin.
Disseminated intravascular coagulation in obstetric
and gynecologic disorders.

Montagnana M, Franchi M, Danese E, Gotsch F, Guidi GC.

Sezione di Chimica Clinica, Dipartimento di Scienze Morfologico-Biomediche, Universit degli

Studi di Verona, Verona, Italy. martina.montagnana@med.lu.se

Abstract

Disseminated intravascular coagulation (DIC) is a syndrome characterized by a massive,

widespread, and ongoing activation of the coagulation system, secondary to a variety of clinical
conditions. Many obstetric complications, such as abruptio placentae, amniotic fluid embolism,
endotoxin sepsis, retained dead fetus, post-hemorrhagic shock, hydatidiform mole, and
gynecologic malignancies, might trigger DIC. In these gynecologic and obstetric settings, DIC is
usually associated with high mortality and morbidity rates. No single laboratory test is sensitive
or specific enough to diagnose DIC definitively, but it can be diagnosed by using a combination
of multiple clinical and laboratory tests that reflect the pathophysiology of the syndrome. At
present, the therapeutical approach to pregnancy- and gynecologic-related DIC comprises the
specific and aggressive treatment of the underlying disease, eventually followed by a supportive
blood product replacement therapy and restoration of physiological anticoagulant pathways. This
article reviews the etiopathogenesis, clinical manifestations, laboratory diagnosis, and therapy of
pregnancy- and gynecologic-related DIC.

http://www.ncbi.nlm.nih.gov/pubmed/20614392
Koagulasi intravaskular disebarluaskan pada
gangguan obstetri dan ginekologi.
M Montagnana, M Franchi, E Danese, Gotsch F, Guidi GC.

Sezione di Clinica Chimica, Dipartimento di Scienze Morfologico-Biomediche, Universit degli

Studi di Verona, Verona, Italia. martina.montagnana @ med.lu.se

Abstrak

yang menyebar koagulasi intravascular (DIC) adalah sindrom ditandai dengan aktivasi besar,
luas, dan berkelanjutan dari sistem koagulasi, sekunder ke berbagai kondisi klinis. Banyak
komplikasi obstetri, seperti abruptio plasenta, emboli cairan ketuban, sepsis endotoksin, ditahan
janin mati, shock pasca-hemoragik, mola hidatidosa, dan keganasan ginekologi, mungkin
memicu DIC. Dalam pengaturan ini ginekologi dan obstetri, DIC biasanya dikaitkan dengan
kematian yang tinggi dan tingkat morbiditas. Tidak ada tes laboratorium tunggal sensitif atau
cukup spesifik untuk mendiagnosis DIC pasti, tetapi dapat didiagnosis dengan menggunakan
kombinasi tes laboratorium klinis dan beberapa yang mencerminkan patofisiologi sindrom. Saat
ini, pendekatan terapi untuk kehamilan-dan ginekologis berhubungan dengan LPS terdiri dari
perawatan yang spesifik dan agresif dari penyakit yang mendasarinya, akhirnya diikuti dengan
terapi produk darah pengganti mendukung dan pemulihan jalur antikoagulan fisiologis. Artikel
ini meninjau etiopathogenesis, manifestasi klinis, diagnosis laboratorium, dan terapi DIC
kehamilan dan ginekologis-terkait.
A case of pregnancy and childbirth after uterine
artery embolization with a permanent embolic agent.

Igarashi S, Izuchi S, Ishizuka B, Yoshimatu M, Takizawa K.

St. Marianna University School of Medicine, Obstetrics and Gynecology, Kawasaki, Japan.

Abstract

OBJECTIVE: To report a case of full-term delivery after uterine artery embolization with N-
butyl cyanoacrylate for abruptio placentae.

DESIGN: Case report.

SETTING: University hospital.

PATIENT(S): A 35-year old woman, gravida 2 para 0, at 32 weeks' and 4 days' gestation.

INTERVENTION(S): Transcatheter arterial embolization with N-butyl cyanoacrylate (NBCA).

RESULT(S): An emergency cesarean section was performed for abruptio placentae. The neonate
died on day 0. After the cesarean section, a hematoma was found at the uterine incision that
continued to increase. Therefore, pelvic angiography was performed, and extravasation was
observed from the uterine arteries. NBCA was used for embolization, and the extravasation
stopped rapidly. Total transfusion volume was 10,190 mL. Nine months after the cesarean
section, the patient became pregnant naturally and delivered a boy by elective cesarean section.

CONCLUSION(S): For treatment of shock caused by perinatal hemorrhage, which is a major

cause of perinatal mortality, even if clotting abnormalities are present, transcatheter arterial
embolization using NBCA can provide effective hemostasis. Moreover, in patients who would
otherwise require a hysterectomy, fertility can be preserved.

http://www.ncbi.nlm.nih.gov/pubmed/20646691
Sebuah kasus kehamilan dan persalinan setelah
embolisasi arteri uterus dengan agen emboli
permanen.
Igarashi S, S Izuchi, B Ishizuka, M Yoshimatu, K. Takizawa

St Marianna University School of Medicine, Obstetri dan Ginekologi, Kawasaki, Jepang.

Abstrak
TUJUAN: Untuk melaporkan kasus pengiriman penuh panjang setelah embolisasi arteri rahim
dengan cyanoacrylate N-butil untuk plasenta abruptio.

DESAIN: Laporan kasus.

SETTING: Universitas rumah sakit.

PASIEN (S): Seorang wanita berusia 35 tahun, gravida 2 butir 0, pada 32 minggu dan 4 hari
kehamilan.

INTERVENSI (S): Transcatheter embolisasi arteri dengan cyanoacrylate N-butil (NBCA).

HASIL (S): Sebuah operasi caesar darurat dilakukan untuk plasenta abruptio. neonatus
meninggal pada 0 hari. Setelah operasi caesar, hematoma ditemukan pada irisan rahim yang terus
meningkat. Oleh karena itu, dilakukan angiografi panggul, dan ekstravasasi diamati dari arteri
rahim. NBCA digunakan untuk embolisasi, dan ekstravasasi berhenti dengan cepat. Volume
transfusi Total 10.190 mL. Sembilan bulan setelah operasi caesar, pasien hamil alami dan
menyampaikan anak laki-laki dengan operasi caesar elektif.

KESIMPULAN (S): Untuk pengobatan syok disebabkan oleh perdarahan perinatal, yang
merupakan penyebab utama kematian perinatal, bahkan jika kelainan pembekuan yang hadir,
transkateter embolisasi arteri menggunakan NBCA dapat menyediakan hemostasis efektif. Selain
itu, pada pasien yang tidak akan membutuhkan histerektomi, kesuburan dapat dilestarikan.