Management of severe bleeding in a ruptured extrauterine pregnancy: a theragnostic approach.
Blood Coagul Fibrinolysis
; 25(2): 176-9, 2014 Mar.
Article
em En
| MEDLINE
| ID: mdl-24253241
ABSTRACT
Haemoperitoneum due to ruptured extrauterine pregnancy is a complication that may occur in the first trimester of pregnancy, but massive haemorrhage with severe shock is rare. When severe bleeding does occur, timely diagnosis and rapid haemostatic treatment are vital. We present the case of a 37-year-old woman with severe bleeding and shock due to ruptured extrauterine pregnancy.Management of the patient consisted of emergency laparotomy, red blood cell transfusion and targeted haemostatic therapy guided by rotational thromboelastometry using the fibrin-based clotting (FIBTEM) assay, (activation with tissue factor with addition of the platelet inhibitor cytochalasin D). As severe hypofibrinogenaemia was apparent, indicated by a FIBTEM maximum clot firmness (MCF) that was not measurable (i.e.â<â2âmm) and a plasma fibrinogen level of 0.17âg/l, the patient was treated with 4âg fibrinogen concentrate. Tranexamic acid (1âg) was also administered.Rapid restoration of haemostasis was indicated by the improvement of thromboelastometric parameters (FIBTEM MCF 16âmm) and, later, laboratory coagulation tests (plasma fibrinogen 2.75âg/l), along with cessation of bleeding. No fresh frozen plasma (FFP) was administered. Surgery was successfully completed, and the patient was subsequently discharged 5 days after admission with no further complications. Haemorrhage in extrauterine pregnancy is commonly managed using autologous blood transfusion (via cell salvage) and homologous plasma transfusion. In this case of severe bleeding and shock due to ruptured extrauterine pregnancy, thromboelastometry-guided administration of fibrinogen concentrate enabled rapid restoration of haemostasis, complete avoidance of FFP transfusion and resulted in a successful outcome.
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Complicações Hematológicas na Gravidez
/
Gravidez Tubária
/
Choque Hemorrágico
/
Ruptura Uterina
Tipo de estudo:
Diagnostic_studies
/
Etiology_studies
Limite:
Adult
/
Female
/
Humans
/
Pregnancy
Idioma:
En
Revista:
Blood Coagul Fibrinolysis
Assunto da revista:
ANGIOLOGIA
/
HEMATOLOGIA
Ano de publicação:
2014
Tipo de documento:
Article
País de afiliação:
Itália