Dieterich Max, Mann Ellen, Wagner Klaus F, Kramer-Steiner Beate, Reimer Toralf, Gerber Bernd, Stubert Johannes
Department of Obstetrics and Gynecology, Südstadt Hospital, University of Rostock, Germany.
Blood Coagul Fibrinolysis. 2011 Dec;22(8):749-51. doi: 10.1097/MBC.0b013e32834aa7f1.
Here we report of a patient who developed a Moschcowitz-like syndrome following a desmopressin treatment of severe postpartum hemorrhage. The patient got an anaphylactic reaction after cervical ripening with dinoproston, leading to an emergency cesarean. A postpartum uterine atony with a blood loss more than 1500 ml resulted in a disseminated intravascular coagulation that was treated with mass transfusion of blood products, including platelets and factor VII. Desmopressin is used as rescue medication in situations of severe bleeding. It was given in this life-threatening situation and presumably triggered a Moschcowitz-like syndrome. Desmopressin exerts its haemostatic effect by releasing von Willebrand factor, which is elevated in pregnancy per se. This results in an increased risk of developing microthrombi, leading to a Moschcowitz-like syndrome. In conclusion, desmopressin should not be administered in pregnant patients owing to its potential risk of triggering the development of thrombotic-thrombocytopenic purpura.
在此，我们报告一例患者，其在去氨加压素治疗严重产后出血后发生了类似Moschcowitz综合征的情况。该患者在用地诺前列酮进行宫颈成熟后出现过敏反应，导致急诊剖宫产。产后子宫收缩乏力伴失血超过1500毫升，引发了弥散性血管内凝血，通过大量输注包括血小板和凝血因子VII在内的血液制品进行治疗。去氨加压素在严重出血情况下用作抢救药物。在这种危及生命的情况下给予了去氨加压素，据推测引发了类似Moschcowitz综合征的情况。去氨加压素通过释放血管性血友病因子发挥止血作用，而血管性血友病因子在妊娠本身就会升高。这导致发生微血栓的风险增加，进而引发类似Moschcowitz综合征的情况。总之，由于去氨加压素具有引发血栓性血小板减少性紫癜的潜在风险，不应在孕妇中使用。
