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妊娠期弥散性血管内凝血:病理生理学、诊断与管理的见解

Disseminated intravascular coagulation in pregnancy: insights in pathophysiology, diagnosis and management.

作者信息

Erez Offer, Mastrolia Salvatore Andrea, Thachil Jecko

机构信息

Department of Obstetrics and Gynecology, Soroka University Medical Center, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel.

Department of Obstetrics and Gynecology, Soroka University Medical Center, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel; Department of Obstetrics and Gynecology, Azienda Ospedaliera Universitaria Policlinico di Bari, Universitá degli Studi di Bari "Aldo Moro", Bari, Italy.

出版信息

Am J Obstet Gynecol. 2015 Oct;213(4):452-63. doi: 10.1016/j.ajog.2015.03.054. Epub 2015 Mar 31.

Abstract

Disseminated intravascular coagulation (DIC) is a life-threatening situation that can arise from a variety of obstetrical and nonobstetrical causes. Obstetrical DIC has been associated with a series of pregnancy complications including the following: (1) acute peripartum hemorrhage (uterine atony, cervical and vaginal lacerations, and uterine rupture); (2) placental abruption; (3) preeclampsia/eclampsia/hemolysis, elevated liver enzymes, and low platelet count syndrome; (4) retained stillbirth; (5) septic abortion and intrauterine infection; (6) amniotic fluid embolism; and (7) acute fatty liver of pregnancy. Prompt diagnosis and understanding of the underlying mechanisms of disease leading to this complication in essential for a favorable outcome. In recent years, novel diagnostic scores and treatment modalities along with bedside point-of-care tests were developed and may assist the clinician in the diagnosis and management of DIC. Team work and prompt treatment are essential for the successful management of patients with DIC.

摘要

弥散性血管内凝血(DIC)是一种危及生命的情况,可由多种产科和非产科原因引起。产科DIC与一系列妊娠并发症相关,包括以下几种:(1)急性产后出血(子宫收缩乏力、宫颈和阴道撕裂伤以及子宫破裂);(2)胎盘早剥;(3)先兆子痫/子痫/溶血、肝酶升高和血小板减少综合征;(4)死胎滞留;(5)感染性流产和宫内感染;(6)羊水栓塞;以及(7)妊娠急性脂肪肝。及时诊断并了解导致这种并发症的潜在疾病机制对于获得良好预后至关重要。近年来,开发了新的诊断评分和治疗方式以及床旁即时检验,可能有助于临床医生对DIC进行诊断和管理。团队协作和及时治疗对于成功管理DIC患者至关重要。

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