Department of Anaesthesia, Liverpool Women's NHS Trust, Crown St., Liverpool, L8 7SS, UK.
Department of Anaesthesia, Liverpool Women's NHS Trust, Crown St., Liverpool, L8 7SS, UK.
Best Pract Res Clin Obstet Gynaecol. 2019 Nov;61:106-120. doi: 10.1016/j.bpobgyn.2019.04.002. Epub 2019 May 6.
The prothrombotic state during pregnancy protects against coagulopathy. Fibrinogen is of key importance with concentrations of 4-6 g/l in parturients preventing the majority of women with postpartum haemorrhage developing hypofibrinogenaemia. However, plasma levels below 2 g/l are strongly predictive of bleed progression and should be maintained above this. Laboratory tests of coagulation have a low sensitivity in major haemorrhage, and results are not quickly available. Viscoelastometry provides rapid results, and the FIBTEM A5 test correlates with fibrinogen levels in PPH. Fibrinogen concentrate or cryoprecipitate is more suitable for fibrinogen replacement in pregnancy than fresh frozen plasma. Formulaic blood product administration results in unnecessary treatment for the majority. Reduced morbidity with viscoelastometry-guided blood product administration has been demonstrated with observational studies but not with randomised controlled trials. Further studies are needed to assess the optimal treatment threshold and outcome benefits from targeted fibrinogen replacement.
妊娠期间的促血栓状态可预防凝血功能障碍。纤维蛋白原具有关键作用，产妇的浓度为 4-6g/L，可预防大多数产后出血患者发生低纤维蛋白原血症。然而，血浆水平低于 2g/L 强烈预示着出血进展，应维持在此之上。凝血的实验室检测在大出血中敏感性较低，且结果不能很快获得。黏弹性测定法可快速提供结果，并且 FIBTEM A5 试验与 PPH 中的纤维蛋白原水平相关。纤维蛋白原浓缩物或冷沉淀比新鲜冷冻血浆更适合用于妊娠中的纤维蛋白原替代。公式化的血液制品管理导致大多数情况下的不必要治疗。观察性研究表明，黏弹性测定法指导下的血液制品管理可降低发病率，但随机对照试验并未证明这一点。需要进一步的研究来评估最佳治疗阈值和靶向纤维蛋白原替代的获益。
