Perinatal Center for Maternity and Neonates, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama, Kanagawa, 232-0024, Japan.
Department of Biostatistics, Yokohama City University School of Medicine, Yokohama, Kanagawa, 236-0004, Japan.
BMC Pregnancy Childbirth. 2022 Nov 17;22(1):847. doi: 10.1186/s12884-022-05187-9.
Placental abruption (PA) with intrauterine fetal death (IUFD) is associated with a high risk of postpartum hemorrhage (PPH) resulting from severe disseminated intravascular coagulation (DIC). Therefore, blood products that are sufficient for coagulation factor replacement must be prepared, and delivery should occur at referral medical institutions that are equipped with sufficient blood products and emergency transfusion protocols. We retrospectively reviewed the records of patients with PA and IUFD (PA-IUFD) to identify possible factors that may indicate the need for early blood transfusion and investigated whether the Japanese scoring system for PPH can be applied in such cases.
We used a database of 16,058 pregnant patients who delivered at Yokohama City University Medical Center between January 2000 and February 2016. Thirty-three patients were diagnosed with PA-IUFD before delivery and categorized into two groups-blood transfusion and non-transfusion-to compare the maternal characteristics and pregnancy outcomes.
In patients with PA-IUFD, the transfusion group exhibited significantly more blood loss; lower fibrinogen levels and platelet counts; higher levels of fibrin degradation products (FDP), D-dimer, and prothrombin time; and a tendency for tachycardia on admission, compared to the non-transfusion group. Many patients in the transfusion group had normal fibrinogen levels on admission but later displayed markedly decreased fibrinogen levels. The Japan Society of Obstetrics and Gynecology (JSOG) DIC score was significantly higher in the transfusion than in the non-transfusion group.
In PA-IUFD, the fibrinogen level, platelet count, D-dimer, FDP, heart rate, and JSOG DIC score on admission may indicate the need for blood transfusion. However, even with normal fibrinogen levels on admission, continuous monitoring is indispensable for identifying progressive fibrinogen reductions in patients with PA-IUFD.
胎盘早剥（PA）合并宫内胎儿死亡（IUFD）可导致弥漫性血管内凝血（DIC）导致严重产后出血（PPH），因此必须准备足够的凝血因子替代用血液制品，分娩应在配备足够血液制品和紧急输血方案的转诊医疗机构进行。我们回顾性分析了胎盘早剥合并宫内胎儿死亡（PA-IUFD）患者的记录，以确定可能需要早期输血的因素，并研究日本 PPH 评分系统是否可用于此类病例。
我们使用了 2000 年 1 月至 2016 年 2 月在横滨市立大学医疗中心分娩的 16058 例孕妇的数据库。33 例患者在分娩前被诊断为 PA-IUFD，并分为输血组和非输血组，以比较母体特征和妊娠结局。
PA-IUFD 患者中，输血组出血量明显更多；纤维蛋白原水平和血小板计数较低；纤维蛋白降解产物（FDP）、D-二聚体和凝血酶原时间水平较高；入院时心率加快趋势明显。许多输血组患者入院时纤维蛋白原水平正常，但后来纤维蛋白原水平明显下降。输血组日本妇产科协会（JSOG）DIC 评分明显高于非输血组。
PA-IUFD 患者入院时的纤维蛋白原水平、血小板计数、D-二聚体、FDP、心率和 JSOG DIC 评分可能提示需要输血。但是，即使入院时纤维蛋白原水平正常，也必须持续监测，以识别 PA-IUFD 患者的纤维蛋白原进行性减少。
