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Chen Y, Jiang W, Zhao Y, Sun D, Zhang X, Wu F, Zheng C. Prostaglandins for Postpartum Hemorrhage: Pharmacology, Application, and Current Opinion. Pharmacology 2021; 106:477-487. [PMID: 34237742 DOI: 10.1159/000516631] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Accepted: 04/10/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Postpartum hemorrhage (PPH) remains a common cause of maternal mortality worldwide. Medical intervention plays an important role in the prevention and treatment of PPH. Prostaglandins (PGs) are currently recommended as second-line uterotonics, which are applied in cases of persistent bleeding despite oxytocin treatment. SUMMARY PG agents that are constantly used in clinical practice include carboprost, sulprostone, and misoprostol, representing the analogs of PGF2α, PGE2, and PGE1, respectively. Injectable PGs, when used to treat PPH, are effective in reducing blood loss but probably induce cardiovascular or respiratory side effects. Misoprostol is characterized by oral administration, low cost, stability in storage, broad availability, and minimal side effects. It remains a treatment option for uterine atony in low-resource settings, but its effectiveness as a uterotonic for independent application may be limited. Key Messages: The present review article discusses the physiological roles of various natural PGs, evaluates the existing evidence of PG analogs in the prevention and treatment of PPH, and finally provides a reference to assist obstetricians in selecting appropriate uterotonics.
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Affiliation(s)
- Yue Chen
- Women's Hospital, Medicine of School, Zhejiang University, Hangzhou, China,
| | - Wei Jiang
- Women's Hospital, Medicine of School, Zhejiang University, Hangzhou, China
| | - Yunchun Zhao
- Women's Hospital, Medicine of School, Zhejiang University, Hangzhou, China
| | - Dongli Sun
- Women's Hospital, Medicine of School, Zhejiang University, Hangzhou, China
| | - Xiao Zhang
- Women's Hospital, Medicine of School, Zhejiang University, Hangzhou, China
| | - Fan Wu
- Women's Hospital, Medicine of School, Zhejiang University, Hangzhou, China
| | - Caihong Zheng
- Women's Hospital, Medicine of School, Zhejiang University, Hangzhou, China
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Postreanimationsbehandlung. Notf Rett Med 2017. [DOI: 10.1007/s10049-017-0331-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Nolan JP, Soar J, Cariou A, Cronberg T, Moulaert VRM, Deakin CD, Bottiger BW, Friberg H, Sunde K, Sandroni C. European Resuscitation Council and European Society of Intensive Care Medicine Guidelines for Post-resuscitation Care 2015: Section 5 of the European Resuscitation Council Guidelines for Resuscitation 2015. Resuscitation 2016; 95:202-22. [PMID: 26477702 DOI: 10.1016/j.resuscitation.2015.07.018] [Citation(s) in RCA: 734] [Impact Index Per Article: 91.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Jerry P Nolan
- Department of Anaesthesia and Intensive Care Medicine, Royal United Hospital, Bath, UK; School of Clinical Sciences, University of Bristol, UK.
| | - Jasmeet Soar
- Anaesthesia and Intensive Care Medicine, Southmead Hospital, Bristol, UK
| | - Alain Cariou
- Cochin University Hospital (APHP) and Paris Descartes University, Paris, France
| | - Tobias Cronberg
- Department of Clinical Sciences, Division of Neurology, Lund University, Lund, Sweden
| | - Véronique R M Moulaert
- Adelante, Centre of Expertise in Rehabilitation and Audiology, Hoensbroek, The Netherlands
| | - Charles D Deakin
- Cardiac Anaesthesia and Cardiac Intensive Care and NIHR Southampton Respiratory Biomedical Research Unit, University Hospital, Southampton, UK
| | - Bernd W Bottiger
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital of Cologne, Cologne, Germany
| | - Hans Friberg
- Department of Clinical Sciences, Division of Anesthesia and Intensive Care Medicine, Lund University, Lund, Sweden
| | - Kjetil Sunde
- Department of Anaesthesiology, Division of Emergencies and Critical Care, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Claudio Sandroni
- Department of Anaesthesiology and Intensive Care, Catholic University School of Medicine, Rome, Italy
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Monsieurs K, Nolan J, Bossaert L, Greif R, Maconochie I, Nikolaou N, Perkins G, Soar J, Truhlář A, Wyllie J, Zideman D. Kurzdarstellung. Notf Rett Med 2015. [DOI: 10.1007/s10049-015-0097-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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Monsieurs KG, Nolan JP, Bossaert LL, Greif R, Maconochie IK, Nikolaou NI, Perkins GD, Soar J, Truhlář A, Wyllie J, Zideman DA, Alfonzo A, Arntz HR, Askitopoulou H, Bellou A, Beygui F, Biarent D, Bingham R, Bierens JJ, Böttiger BW, Bossaert LL, Brattebø G, Brugger H, Bruinenberg J, Cariou A, Carli P, Cassan P, Castrén M, Chalkias AF, Conaghan P, Deakin CD, De Buck ED, Dunning J, De Vries W, Evans TR, Eich C, Gräsner JT, Greif R, Hafner CM, Handley AJ, Haywood KL, Hunyadi-Antičević S, Koster RW, Lippert A, Lockey DJ, Lockey AS, López-Herce J, Lott C, Maconochie IK, Mentzelopoulos SD, Meyran D, Monsieurs KG, Nikolaou NI, Nolan JP, Olasveengen T, Paal P, Pellis T, Perkins GD, Rajka T, Raffay VI, Ristagno G, Rodríguez-Núñez A, Roehr CC, Rüdiger M, Sandroni C, Schunder-Tatzber S, Singletary EM, Skrifvars MB, Smith GB, Smyth MA, Soar J, Thies KC, Trevisanuto D, Truhlář A, Vandekerckhove PG, de Voorde PV, Sunde K, Urlesberger B, Wenzel V, Wyllie J, Xanthos TT, Zideman DA. European Resuscitation Council Guidelines for Resuscitation 2015: Section 1. Executive summary. Resuscitation 2015; 95:1-80. [PMID: 26477410 DOI: 10.1016/j.resuscitation.2015.07.038] [Citation(s) in RCA: 564] [Impact Index Per Article: 62.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Koenraad G Monsieurs
- Emergency Medicine, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium; Faculty of Medicine and Health Sciences, University of Ghent, Ghent, Belgium.
| | - Jerry P Nolan
- Anaesthesia and Intensive Care Medicine, Royal United Hospital, Bath, UK; School of Clinical Sciences, University of Bristol, Bristol, UK
| | | | - Robert Greif
- Department of Anaesthesiology and Pain Medicine, University Hospital Bern, Bern, Switzerland; University of Bern, Bern, Switzerland
| | - Ian K Maconochie
- Paediatric Emergency Medicine Department, Imperial College Healthcare NHS Trust and BRC Imperial NIHR, Imperial College, London, UK
| | | | - Gavin D Perkins
- Warwick Medical School, University of Warwick, Coventry, UK; Heart of England NHS Foundation Trust, Birmingham, UK
| | - Jasmeet Soar
- Anaesthesia and Intensive Care Medicine, Southmead Hospital, Bristol, UK
| | - Anatolij Truhlář
- Emergency Medical Services of the Hradec Králové Region, Hradec Králové, Czech Republic; Department of Anaesthesiology and Intensive Care Medicine, University Hospital Hradec Králové, Hradec Králové, Czech Republic
| | - Jonathan Wyllie
- Department of Neonatology, The James Cook University Hospital, Middlesbrough, UK
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Devaux Y, Stammet P, Friberg H, Hassager C, Kuiper MA, Wise MP, Nielsen N. MicroRNAs: new biomarkers and therapeutic targets after cardiac arrest? CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2015; 19:54. [PMID: 25886727 PMCID: PMC4324045 DOI: 10.1186/s13054-015-0767-2] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Despite advances in resuscitation medicine, including target temperature management as part of post-cardiac arrest care, many patients will have a poor neurological outcome, most often resulting in death. It is a commonly held belief that the ability to prognosticate outcome at an early stage after cardiac arrest would allow subsequent health care delivery to be tailored to individual patients. However, currently available predictive methods and biomarkers lack sufficient accuracy and therefore cannot be generally recommended in clinical practice. MicroRNAs have recently emerged as potential biomarkers of cardiovascular diseases. While the biomarker value of microRNAs for myocardial infarction or heart failure has been extensively studied, less attention has been devoted to their prognostic value after cardiac arrest. This review highlights the recent discoveries suggesting that microRNAs may be useful both to predict outcome and to treat patients after cardiac arrest.
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Affiliation(s)
- Yvan Devaux
- Laboratory of Cardiovascular Research, Luxembourg Institute of Health, L-1526, Luxembourg, Luxembourg.
| | - Pascal Stammet
- Department of Anaesthesia and Intensive Care Medicine, Centre Hospitalier, L-1445, Luxembourg, Luxembourg.
| | - Hans Friberg
- Skane University Hospital, Lund University, SE-205 02, Malmo, Sweden.
| | - Christian Hassager
- Department of Cardiology, The Heart Center, Rigshospitalet, DK - 2100, Copenhagen, Denmark.
| | - Michael A Kuiper
- Department of Intensive Care Medicine, Medical Center Leeuwarden, 8934 AD, Leeuwarden, The Netherlands.
| | - Matt P Wise
- Adult Critical Care, University Hospital of Wales, Cardiff, CF14 4XW, UK.
| | - Niklas Nielsen
- Helsingborg Hospital, Lund University, S-251 87, Helsingborg, Sweden.
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Braunecker S, Böttiger BW. Predicting Outcome After Cardiac Arrest. Resuscitation 2014. [DOI: 10.1007/978-88-470-5507-0_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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9
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Medical prevention and treatment of postpartum hemorrhage: a comparison of different guidelines. Arch Gynecol Obstet 2013; 289:555-67. [DOI: 10.1007/s00404-013-3016-4] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2013] [Accepted: 08/26/2013] [Indexed: 10/26/2022]
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Sandroni C, Cavallaro F, Callaway CW, Sanna T, D'Arrigo S, Kuiper M, Della Marca G, Nolan JP. Predictors of poor neurological outcome in adult comatose survivors of cardiac arrest: a systematic review and meta-analysis. Part 1: patients not treated with therapeutic hypothermia. Resuscitation 2013; 84:1310-23. [PMID: 23811182 DOI: 10.1016/j.resuscitation.2013.05.013] [Citation(s) in RCA: 146] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2013] [Revised: 05/16/2013] [Accepted: 05/20/2013] [Indexed: 11/30/2022]
Abstract
AIMS AND METHODS To systematically review the accuracy of early (≤7 days) predictors of poor outcome defined as death or vegetative state (Cerebral Performance Categories [CPC] 4-5) or death, vegetative state or severe disability (CPC 3-5) in comatose survivors from cardiac arrest not treated using therapeutic hypothermia (TH). PubMed, Scopus and the Cochrane Database of Systematic reviews were searched for eligible studies. Sensitivity, specificity, false positive rates (FPR) for each predictor were calculated and results of predictors with similar time points and outcome definitions were pooled. Quality of evidence (QOE) was evaluated according to the GRADE guidelines. RESULTS 50 studies (2828 patients) were included in final analysis. Presence of myoclonus at 24-48h, bilateral absence of short-latency somatosensory evoked potential (SSEP) N20 wave at 24-72h, absence of electroencephalographic activity >20-21μV ≤72h and absence of pupillary reflex at 72h predicted CPC 4-5 with 0% FPR and narrow (<10%) 95% confidence intervals. Absence of SSEP N20 wave at 24h predicted CPC 3-5 with 0% [0-8] FPR. Serum thresholds for 0% FPR of biomarkers neuron specific enolase (NSE) and S-100B were highly inconsistent among studies. Most of the studies had a low or very low QOE and did not report blinding of the treating team from the results of the investigated predictor. CONCLUSIONS In comatose resuscitated patients not treated with TH presence of myoclonus, absence of pupillary reflex, bilateral absence of N20 SSEP wave and low EEG voltage each predicted poor outcome early and accurately, but with a relevant risk of bias.
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Affiliation(s)
- Claudio Sandroni
- Department of Anaesthesiology and Intensive Care, Catholic University School of Medicine, Rome, Italy.
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11
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LAMPATI L, COLANTONIO LB, CALDERINI E. Cardiac arrest during sulprostone administration--a case report. Acta Anaesthesiol Scand 2013. [PMID: 23185977 DOI: 10.1111/aas.12022] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Sulprostone, a synthetic prostaglandin analogue with potent uterotonic action, has been shown to have a low complication rate in a large series. We present a case of cardiac arrest in a parturient after Caesarean section during continuous infusion of intravenous sulprostone administered for atonic post-partum haemorrhage. She had cardiopulmonary resuscitation for 25 min before spontaneous circulation returned. The sequence of events, the results of investigations carried out during the intensive care unit stay, and the presence of multiple cardiovascular risk factors, suggest that sulprostone caused coronary spasm, bradycardia, and subsequent asystole, similar to other cases described in the literature.
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Affiliation(s)
- L. LAMPATI
- Dipartimento di Anestesia; Terapia Intensiva e Terapia del Dolore; Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico; Milano; Italy
| | - L. B. COLANTONIO
- Dipartimento di Anestesia; Terapia Intensiva e Terapia del Dolore; Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico; Milano; Italy
| | - E. CALDERINI
- Dipartimento di Anestesia; Terapia Intensiva e Terapia del Dolore; Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico; Milano; Italy
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STEFANOVIC VEDRAN, PAAVONEN JORMA, LOUKOVAARA MIKKO, HALMESMÄKI ERJA, AHONEN JOUNI, TIKKANEN MINNA. Intravenous sulprostone infusion in the treatment of retained placenta. Acta Obstet Gynecol Scand 2012; 92:426-32. [DOI: 10.1111/j.1600-0412.2012.01506.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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13
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Cellier Q, Gamerre L, Cortey C, Clement HJ, Viale JP. [Severe hyperthermia and neurological disorders following prostaglandin treatment for uterine atonia after caesarean section]. ANNALES FRANCAISES D'ANESTHESIE ET DE REANIMATION 2012; 31:243-245. [PMID: 22364765 DOI: 10.1016/j.annfar.2012.01.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/05/2011] [Accepted: 01/12/2012] [Indexed: 05/31/2023]
Abstract
Uterine atony is the most frequent cause of post-partum haemorrhage. In France, the management is based on early administration of oxytocic agents and prostaglandin analogues (sulprostone-Nalador®). We report the case of a 30-year-old woman who presented soon after administration of sulprostone, a severe hyperthermia with neurological disorders. A complete reversibility was observed a few hours after discontinuation of sulprostone administration. Other causes were eliminated by biological and radiological findings.
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Affiliation(s)
- Q Cellier
- Département d'anesthésie-réanimation, hôpital de la Croix-Rousse, 103, Grande-Rue-de-la-Croix-Rousse, 69317 Lyon cedex 04, France
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Prostaglandin E2 Analogue Sulprostone for Treatment of Atonic Postpartum Hemorrhage. Obstet Gynecol 2011; 118:257-265. [DOI: 10.1097/aog.0b013e3182255335] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Barillari G, Frigo MG, Casarotto M, Farnia A, Massè B, Wetzl R, Bianchin A, Rabi A, Malacarne P, Pasca S, Bigotto E. Use of recombinant activated factor VII in severe post-partum haemorrhage: data from the Italian Registry: a multicentric observational retrospective study. Thromb Res 2009; 124:e41-7. [PMID: 19783283 DOI: 10.1016/j.thromres.2009.08.018] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2008] [Revised: 08/10/2009] [Accepted: 08/18/2009] [Indexed: 10/20/2022]
Abstract
PURPOSE To report the Italian real experience in clinical practice about recombinant factor VII activated (rFVIIa) in Post-Partum Haemorrhage (PPH) treatment. METHODS An Italian retrospective survey of severe primary PPH cases treated with rFVIIa was performed. Anamnestic, clinical and haemostatic data about thirty-five patients with PPH, from 2005 to 2007, were collected. Coagulative parameters and transfusion requirements before and after rFVIIa treatment were compared. RESULTS After rFVIIa administration INR was significantly decreased, while fibrinogen levels were markedly increased. Median of packed red blood cells units, platelets units, fresh frozen plasma, crystalloids and colloids needed, before and after rFVIIa administration, were respectively 6 and 2 units (p<1.2exp-6), 1.5 and 0 units (p=0.001), 1250 and 0 mL (p<4.4exp-5), 3000 and 1250 mL (p<0,0042). Twenty-nine of 35 patients needed surgical intervention before rFVIIa administration, 9/35 after treatment. Hysterectomies have been performed respectively in 10/35 cases before and in 6/35 cases after rFVIIa infusion. No maternal deaths have been reported. No adverse events or thromboembolic complications were observed. CONCLUSIONS Our clinical and haemostatic data suggest that recombinant activated factor VII may be a safe and helpful adjunctive therapy in the PPH management.
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Affiliation(s)
- Giovanni Barillari
- Center for Hemorrhagic and Thrombotic Diseases, Department of Transfusion Medicine, General University Hospital of Udine, Italy.
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Hagenaars M, Knape J, Backus E. Pulmonary oedema after high infusion rate of sulprostone. Br J Anaesth 2009; 102:281-2. [DOI: 10.1093/bja/aen372] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Use of recombinant activated factor VII in massive postpartum haemorrhage. Eur J Obstet Gynecol Reprod Biol 2008; 137:172-7. [DOI: 10.1016/j.ejogrb.2007.06.022] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2006] [Revised: 05/31/2007] [Accepted: 06/14/2007] [Indexed: 11/20/2022]
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Morel O, Gayat E, Malartic C, Desfeux P, Rossignol M, Le Dref O, Fargeaudou Y, Mebazaa A, Barranger E, Judlin P. Hémorragies graves au cours de la grossesse et du post-partum. Choc hémorragique. ACTA ACUST UNITED AC 2008. [DOI: 10.1016/s0246-0335(08)45768-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Lozano H, Wu D, Bassuk J, Aria J, Kurlansky P, Lamas GA, Adams JA. The effects of prostaglandin inhibition on whole-body ischemia-reperfusion in swine. Am J Emerg Med 2008; 26:45-53. [DOI: 10.1016/j.ajem.2007.10.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2007] [Accepted: 10/04/2007] [Indexed: 12/24/2022] Open
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Hofer S, Schreckenberger R, Heindl B, Görlinger K, Lier H, Maul H, Martin E, Weigand MA. Blutungen während der Schwangerschaft. Anaesthesist 2007; 56:1075-89; quiz 1090. [PMID: 17901937 DOI: 10.1007/s00101-007-1261-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Hemorrhaging during pregnancy is often fulminant and life-threatening for mother and child. Of maternal deaths occurring during pregnancy, 25% are caused by hemorrhaging. All physicians involved in the interdisciplinary treatment of hemorrhaging during pregnancy need to be familiar with the specific pathophysiology of hemostatic changes during pregnancy, e.g. elevated hemostatic capacity, reduced anti-coagulation activity and severe alterations of the fibrinolysis system. Therapists must be able to perform a consequent, goal-directed interdisciplinary approach to prevent adverse maternal and fetal outcomes. The major issues of therapy are causal obstetric treatment of the bleeding, early detection and therapy of hyperfibrinolysis, optimization of fibrinogen and platelet levels and knowledge of the possibilities of a targeted coagulation therapy.
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Affiliation(s)
- S Hofer
- Klinik für Anästhesiologie, Universitätsklinikum Heidelberg, Heidelberg.
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Reyftmann L, Morau E, Dechaud H, Herve D, Frapier JM, Jean-Marc F, Hedon B, Bernard H. Extracorporeal membrane oxygenation therapy for circulatory arrest due to postpartum hemorrhage. Obstet Gynecol 2006; 107:511-4. [PMID: 16449168 DOI: 10.1097/01.aog.0000173970.67736.92] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Cardiac arrest after postpartum hemorrhage may not respond to advanced life support. Various resuscitation methods have been proposed, including sternotomy and direct cardiac massage. Extracorporeal membrane oxygenation (ECMO) might be an alternative. CASE We report the case of a woman who suffered atonic uterine hemorrhage perioperatively after cesarean delivery of twins. During initial conservative treatment using prostaglandin analog (sulprostone), cardiac decompensation developed and was followed by cardiopulmonary arrest. Circulatory failure remained unresponsive after 2 hours of resuscitation, when ECMO was initiated. The ensuing recovery was favorable. CONCLUSION Aggressive mechanical circulatory support, such as ECMO, should be considered in a case of potentially reversible cardiocirculatory failure in a young obstetric patient.
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Affiliation(s)
- Lionel Reyftmann
- Department of Obstetrics and Gynecology, A. de Villeneuve University Hospital, France.
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van Beekhuizen HJ, de Groot ANJA, De Boo T, Burger D, Jansen N, Lotgering FK. Sulprostone reduces the need for the manual removal of the placenta in patients with retained placenta: a randomized controlled trial. Am J Obstet Gynecol 2006; 194:446-50. [PMID: 16458644 DOI: 10.1016/j.ajog.2005.08.029] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2005] [Revised: 07/23/2005] [Accepted: 08/11/2005] [Indexed: 10/25/2022]
Abstract
OBJECTIVE The purpose of this study was to determine the extent that the administration of sulprostone reduces the need for manual removal of the placenta in patients with retained placenta. STUDY DESIGN A double-blinded sequential randomized controlled trial of sulprostone versus placebo was conducted among 103 patients with retained placenta. RESULTS In the first phase of this sequential study, sulprostone was compared with placebo. The null hypothesis of equal effectiveness of both treatments was rejected after 50 patients. In patients with retained placenta, the placenta was expelled after sulprostone in 13 of 24 cases (51.8%, bias adjusted), whereas expulsion after placebo was achieved in only 4 of 26 cases (17.6%, bias adjusted). The difference was significant (P = .034). In the second phase of the study, in which the placebo arm was stopped, results were confirmed; in 25 of 53 patients (47%), the placenta was expelled. CONCLUSION Sulprostone reduces the need for the manual removal of the placenta by 49%.
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Abstract
PURPOSE OF REVIEW An estimated 0.5-4% of pregnant patients have cardiac disease, such as rheumatic disease, which is decreasing in Western countries, uncorrected congenital heart disease, cardiomyopathy and ischaemic heart disease. There has been an increase in maternal mortality due to cardiac causes. Congenital heart disease is becoming the most common source of cardiac problems in the pregnant patient, because patients are increasingly likely to survive to childbearing age with the improvement of surgery. RECENT FINDINGS The increasing age of patients conceiving their first child is also an important factor. A comprehensive understanding of the physiology of pregnancy and the pathophysiology of maternal cardiac disease is of great importance for anaesthesiologists, gynaecologists and cardiologists involved in peripartum care. SUMMARY We try to give a brief and comprehensive review on this topic.
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Affiliation(s)
- P Boris W Cox
- Department of Anaesthesiology and Pain Management, University Hospital Maastricht, The Netherlands
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Biermann C, Tosin S, Bayoumeu F, Savoye E, Bouaziz H. Choc anaphylactique et atonie utérine : faut-il utiliser le sulprostone ? ACTA ACUST UNITED AC 2005; 24:69-70. [PMID: 15661469 DOI: 10.1016/j.annfar.2004.11.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Pelinka LE, Jafarmadar M, Redl H, Bahrami S. NEURON-SPECIFIC-ENOLASE IS INCREASED IN PLASMA AFTER HEMORRHAGIC SHOCK AND AFTER BILATERAL FEMUR FRACTURE WITHOUT TRAUMATIC BRAIN INJURY IN THE RAT. Shock 2004; 22:88-91. [PMID: 15201708 DOI: 10.1097/01.shk.0000130157.34382.3f] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Neuron-specific enolase (NSE) is an acknowledged marker of traumatic brain injury. Several markers originally considered reliable in the setting of traumatic brain injury have been challenged after having been studied more extensively. The aim of our experimental study was to determine whether NSE is a reliable marker of traumatic brain injury early after trauma. Hemorrhagic shock was achieved by bleeding anesthetized rats to a mean arterial pressure (MAP) of 30-35 mmHg through a femoral catheter until incipient decompensation. MAP was maintained at 30-35 mmHg until 40% of shed blood had been administered as Ringer's solution and was then increased and maintained at 40-45 mmHg for 40 min by further administration of Ringer's solution, mimicking the phase of inadequate preclinical resuscitation. Blood samples were drawn at the end of the 40-min period of inadequate resuscitation. Femur fracture was achieved in anesthetized rats by bilateral application of forceps. Blood samples were drawn 30 and 60 min after fracture. Hemorrhagic shock caused NSE increase versus laboratory controls at the end of inadequate resuscitation (P < 0.01). Bilateral femur fracture caused NSE increase versus laboratory controls 30 min after fracture, which was significant 60 min after fracture (P < 0.01). During femur fracture, MAP remained at a level that is not associated with shock in rats. Our findings show for the first time that NSE increases after hemorrhagic shock as well as after femur fracture without hemorrhagic shock in rats. From a clinical point of view, these findings indicate that NSE cannot be considered a reliable marker of traumatic brain injury early after trauma in cases associated with hemorrhagic shock and/or femur fracture.
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Affiliation(s)
- Linda E Pelinka
- Ludwig Boltzmann Institute for Experimental and Clinical Traumatology and Research Center of the Worker's Compensation Board (AUVA), Vienna, Austria.
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