Maslow A D, Breen T W, Sarna M C, Soni A K, Watkins J, Oriol N E
Department of Anesthesia and Critical Care, Beth Israel Hospital, Harvard Medical School, Boston, MA 02215, USA.
Can J Anaesth. 1996 Dec;43(12):1237-43. doi: 10.1007/BF03013432.
The purpose of this study was to determine factors associated with abnormal coagulation in the setting of intrauterine fetal death (IUFD).
We reviewed the charts of 238 patients diagnosed with IUFD over ten years. Data included demographics, co-existing obstetric disease and coagulation studies. A coagulation score was assigned based on the platelet count, prothrombin time, activated partial thromboplastin time and plasma fibrinogen concentration. Approximately 90% of the study population had coagulation scores < 4. A score of > or = 4 was considered abnormal.
Complete coagulation analysis was available in 183/238 patients (77%) within 24 hr of delivery. One hundred and sixty-four of these (89.6%) had a coagulation score, < 4 and 19 had a score > or = 4 (10.4%). No relationship between the coagulation score and age, parity, gestational age at delivery, and number of days the dead fetus remained in utero was found. A coagulation score > = or 4 was associated with the presence of a pregnancy-related disease (P < 0.05), notably abruption (P < 0.001) and uterine perforation (P < 0.05). Four patients without co-existing disease (3.2%), had a coagulation score > or = 4.
In most pregnancies complicated by fetal demise, the fetus and placenta are delivered within one week of fetal demise. The previously reported severe coagulation disturbances are largely eliminated by early delivery. Our study shows that coagulation abnormalities occur in some patients with uncomplicated IUFDs (3.2%) and that this number rises in the presence of abruption or uterine perforation.
本研究的目的是确定与宫内死胎（IUFD）情况下凝血异常相关的因素。
我们回顾了10年间238例诊断为IUFD患者的病历。数据包括人口统计学资料、并存的产科疾病和凝血研究。根据血小板计数、凝血酶原时间、活化部分凝血活酶时间和血浆纤维蛋白原浓度指定一个凝血评分。大约90%的研究人群凝血评分为<4。评分>或 = 4被认为异常。
183/238例患者（77%）在分娩后24小时内进行了完整的凝血分析。其中164例（89.6%）凝血评分为<4，19例评分>或 = 4（10.4%）。未发现凝血评分与年龄、产次、分娩时孕周以及死胎在子宫内停留天数之间存在关联。凝血评分> = 或4与妊娠相关疾病的存在相关（P < 0.05），尤其是胎盘早剥（P < 0.001）和子宫穿孔（P < 现0.05）。4例无并存疾病的患者（3.2%）凝血评分>或 = 4。
在大多数并发胎儿死亡的妊娠中，胎儿和胎盘在胎儿死亡后一周内娩出。先前报道的严重凝血障碍在早期分娩后基本消除。我们的研究表明，一些无并发症的IUFD患者（3.2%）会出现凝血异常，并且在存在胎盘早剥或子宫穿孔时这一比例会升高。
