Bachmann Cornelia, Abele Harald, Wallwiener Diethelm, Kagan Karl Oliver
Department of Gynecology, University Tübingen, Calwer Str. 7, 72070, Tübingen, Germany,
Arch Gynecol Obstet. 2014 Jun;289(6):1193-5. doi: 10.1007/s00404-013-3110-7. Epub 2013 Dec 13.
Challenges of modern medicine are peripartum bleeding complications as one of the most frequent cases of emergency in obstetrics with a prevalence of 0.5-5.0 %, meaning the main cause of maternal morbidity and mortality. In this context, inherited diseases such as Hermansky-Pudlak syndrome (HPS) should be recognized. HPS is a rare disease and belongs to a heterogeneous group of autosomal recessive disorders characterized by the triad of partial oculocutaneous albinism, disorder of "ceroid" metabolism and platelet storage pool deficiency with bleeding disorder.
We report on a 30-year-old primipara, to show the peripartum obstetrical and anaesthesiological management. The patient presented with contractions in our outpatient department in the 39th gestational week. In previous operations there were bleeding complications due to HPS.
Therefore, to minimize bleeding complications we aimed a vaginal birth, advised against the peridural anesthesia and optimized the coagulation parameters. The subsequent delivery was performed as vacuum extraction without complications. Patient and newborn could be discharged from the hospital without complications.
In conclusion, decisive factor for patients with bleeding disorders is a close interdisciplinary cooperation between obstetrician and anesthesiologist.
现代医学面临的挑战之一是围产期出血并发症,这是产科最常见的紧急情况之一,患病率为0.5%-5.0%,是孕产妇发病和死亡的主要原因。在这种情况下,应认识到诸如赫尔曼斯基-普德拉克综合征(HPS)等遗传性疾病。HPS是一种罕见疾病,属于常染色体隐性疾病的异质性群体,其特征为部分眼皮肤白化病、“类蜡质”代谢紊乱以及伴有出血性疾病的血小板储存池缺陷三联征。
我们报告了一名30岁初产妇的情况,以展示围产期的产科和麻醉管理。该患者在妊娠第39周时在我们的门诊部出现宫缩。在之前的手术中,因HPS出现了出血并发症。
因此,为尽量减少出血并发症,我们旨在进行阴道分娩,不建议使用硬膜外麻醉,并优化凝血参数。随后的分娩通过真空吸引进行,无并发症发生。患者和新生儿均无并发症出院。
总之,对于有出血性疾病的患者,决定性因素是产科医生和麻醉医生之间密切的跨学科合作。