Wing D A, Paul R H, Millar L K
Department of Obstetrics-Gynecology, University of Southern California School of Medicine, Los Angeles, USA.
Am J Perinatol. 1997 Nov;14(10):601-4. doi: 10.1055/s-2008-1040761.
We conducted this study to ascertain the usefulness of coagulation studies and blood bank utilization in the patient with symptomatic placenta previa. During a 2-year interval, 97 patients with uterine bleeding due to placenta previa diagnosed > or = 24 weeks' gestation were evaluated. The following studies were routinely obtained: complete blood count including platelet count, fibrinogen, prothrombin time, and a Kleihauer-Betke test. A type and cross-match was sent to the blood bank, and blood availability was maintained for all patients throughout the course of hospitalization. For 92 of 97 patients the laboratory values and need for immediate blood availability were analyzed. No abnormal prothrombin times or Kleihauer-Betke tests were found. There was one low fibrinogen value in a patient with a normal complete blood count. The initial hematocrits ranged from 16.5 to 40.0%, and the initial hemoglobins ranged from 5.5 to 14.1 mg/dL. Five patients had platelet counts of < or = 150 k/mm3 (range 75 to 149 k/mm3). Fourteen patients (14.6%) required transfusion, two received their transfusion antepartum and 12 received perioperative transfusion with a cesarean delivery. During this time period, only two patients required emergent delivery within 1 hr of presentation to the hospital. One patient had delayed seeking medical attention for more than 3 hr prior to admission despite significant hemorrhage. Coagulation studies and Kleihauer-Betke tests have limited utility in the symptomatic patient with uterine bleeding from placenta previa. Continuous availability of cross-matched blood in the antepartum period appears unnecessary as no patients in this investigation were transfused emergently.
我们开展这项研究以确定凝血检查及血库用血在有症状前置胎盘患者中的作用。在两年期间，对97例妊娠≥24周因前置胎盘导致子宫出血的患者进行了评估。常规进行了以下检查：全血细胞计数，包括血小板计数、纤维蛋白原、凝血酶原时间以及改良寇氏试验。向血库送检血型及交叉配血，在整个住院期间为所有患者维持血液供应。对97例患者中的92例分析了实验室检查值及即刻用血需求。未发现凝血酶原时间或改良寇氏试验异常。1例全血细胞计数正常的患者纤维蛋白原值偏低。初始血细胞比容范围为16.5%至40.0%，初始血红蛋白范围为5.5至14.1mg/dL。5例患者血小板计数≤150k/mm³（范围为75至149k/mm³）。14例患者（14.6%）需要输血，2例在产前输血，12例在剖宫产围手术期输血。在此期间，仅2例患者在入院后1小时内需要紧急分娩。1例患者尽管出血严重，但在入院前3小时以上才延迟就医。凝血检查及改良寇氏试验在有症状的前置胎盘子宫出血患者中的作用有限。产前持续备有交叉配血的血液似乎没有必要，因为本研究中没有患者紧急输血。
