INTRODUCTION. Massive obstetric bleeding is the most common cause of maternal
mortality and morbidity. The first step in treatment of these patients is
establishing the adequate circulatory volume. The primary goal of therapy is
to identify and remove the cause of bleeding, with appropriate symptomatic
and substitution therapy. Human recombinant activated factor VII (rFVIIa) is
officially registered for the treatment of patients suffering from
haemophilia with inhibitors. Its use has also proved successful in other
congenital and acquired coagulopathies and in patients with acute
non-haemophilic bleeding. A special significance is given to the application
of rFVIIa in cases of obstetric haemorrhage, in order to avoid postpartum
hysterectomy and occurrence of complications of haemorrhagic shock in
obstetrics. OBJECTIVE. The aim of this study is to show our experience and
results of the use of rFVIIa in the treatment of patients with massive
postpartum bleeding. METHOD. The retrospective study encompassed six patients
with primary postpartum haemorrhage treated with rFVIIa at our institution in
the period from 2005 to 2007. RESULTS. The treated patients were divided into
two groups. In the first group, there were three patients who underwent
hysterectomy and who received rFVIIa over 24 hours after delivery. The second
group consisted of three patients who received rFVIIa in the first 24 hours
after delivery, before we decided to perform hysterectomy. The application of
rFVIIa led to successful cessation of bleeding in all patients. Relevant side
effects were not registered. CONCLUSION. The administration of rFVIIa in
obstetrics should be considered for each patient before decision to apply
hysterectomy, and it should certainly be applied in patients who want to
preserve the uterus and fertile capability. According to our experience, in
cases of postpartum hemorrhagia rFVIIa is to be administered in intravenous
bolus doses of at least 90 mcg/kg, at least 6 hours after the onset of
bleeding. rFVIIa is not an alternative to adequate surgical haemostasis;
therefore, it needs to be administered after its detailed revision.
During 3 year period there were over 20000 deliveries at the Institute for Gynecology and Obstetrics. Considering the fact that our clinic's maternity hospital is the largest in the Balkans and that we are at the top of medical practice, the largest number of deliveries in Serbia and Monte Negro is performed in our institution. For the number of uterus ruptures dramatically increased, we analyzed the way of their repair and possible measures for preventing postpartum hysterectomies. We compared patients with performed hysterectomies or uterus sutures. We analyzed the possibility to approach more conservatively to such complications. 30 patients were subjected to interventions. In the group A there were 25 women subjected to more conservative therapy. In the group B there were 5 patients with total hysterectomy with conservation of one or both adnexes.
Acceleration of fetal maturation, and delivery between 34 and 36 weeks, appears to be a promising means to reduce or even eliminate the permanent sequelae of fetal hyperinsulinemia in pregnancies complicated by GDM.
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