Infusion-transfusion therapy during cesarean section in pregnant women with placenta increta
Objective. To evaluate infusion-transfusion therapy during cesarean section in pregnant women with placenta previa et increta.Fedorova T.A., Shmakov R.G., Rogachevsky O.V., Pyregov A.V., Strelnikova E.V., Vinitsky A.A., Korolev A.Yu.
Material and methods. A study group consisted of 15 patients with placenta previa et increta. They delivered babies at 32-36 weeks’ gestation. Clinical and laboratory examinations and special studies were applied. Infusion-transfusion therapy and postoperative complications were analyzed.
Results. The mean age of the pregnant women was 33.8±4.3 years. All the pregnant women underwent bottom cesarean section. Organ-sparing surgery (metroplasty) was performed in 12 (80%) women; three (20%) had hysterectomy. Intraoperative blood loss ranged from 750 ml to 6000 ml and averaged 2471.42±1528.53 ml.
The volume of crystalloid sterofundin solutions was 1361.53±1052.40 ml and that of other solutions was 688.4±123.5 ml. 80% of the patients were injected with colloidal solutions, such as gelofuzin averaged 969.66±351.86 ml; geoplasma did 620.8±124.8 ml. The volume of 6% hydroxyethyl starch (HES) 130/04 solutions averaged 744.4±120.45 ml. Fresh frozen plasma in an amount of 1526.7±762.83 ml was transfused in 60% of the women. The average dose of tranexamic acid was 2.6±0.84 g. Recombinant activated factor VII (rFVIIa) 90 µg/kg was administered to three patients. Prothrombin complex concentrate (1200 units) was infused in 3 patients. The volume of reinfused autoerythrocytes averaged 793.7±424.17 ml. That of donor red blood cells during surgery amounted to 775.1±120.2 ml.
Conclusion. In placenta previa et increta, the complex infusion-transfusion program for surgical delivery, by applying the current technologies, and a multidisciplinary approach allow organ-sparing tactics to be implemented in 80% of the women.
Keywords
pregnancy
placenta previa et increta
infusion-transfusion therapy
blood-sparing technologies
Supplementary Materials
- Table 1. Indicators of the hemostatic system of patients with placenta ingrowth at different stages of the study
- Table 2. Indicators of the level of erythrocytes, hemoglobin and hematocrit in patients with placenta ingrowth at different stages of the study
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Received 14.04.2017
Accepted 28.04.2017
About the Authors
Fedorova Tatiana Anatolyevna, Ph.MD, Chief of transfusion department, Research Center of Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia.117485, Russia , Moscow, Ac. Oparina str. 4. Теl.: +74954387135. E-mail: t_fyodorova@oparina4.ru
Shmakov Roman Georgievich, MD, chief medical officer оf Research Center of Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia.
117485, Russia , Moscow, Ac. Oparina str. 4. Теl.: +74954381800. E-mail: r_shmakov@oparina4.ru
Rogachevskiy Oleg Vladimirovich, MD, head of the Department of extracorporal methods of treatment and detoxification, Research Center of Obstetrics,
Gynecology and Perinatology, Ministry of Health of Russia. 117485, Russia , Moscow, Ac. Oparina str. 4. Теl.: +74954387135. E-mail: о_rogachevskiy@oparina4.ru
Pyregov Alexey Viktorovich, MD, head of the department of anesthesiology and intensive care, Research Center of Obstetrics, Gynecology and Perinatology,
Ministry of Health of Russia. 117485, Russia , Moscow, Ac. Oparina str. 4. Теl.: +74954387777. E-mail: a_pyregov@oparina4.ru
Strelnikova Elena Vladimirovna, candidate of medical sciences, doctor of the Department of extracorporal methods of treatment and detoxification,
Research Center of Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia.
117485, Russia , Moscow, Ac. Oparina str. 4. Теl.: +74954387135. E-mail: e_strelnikova@oparina4.ru
Vinitskiy Alexander Anatolyevich, the graduate student of Research Center of Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia.
117485, Russia , Moscow, Ac. Oparina str. 4. Теl.: +74954387743. E-mail: a_vinitsckiy@oparina4.ru
Korolev Alexey Yurevich, doctor of anesthesiology and intensive care, Research Center of Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia. 1
17485, Russia , Moscow, Ac. Oparina str. 4. Теl.: +74954387777. a_korolyov@oparina4.ru
For citations: Fedorova T.A., Shmakov R.G., Rogachevsky O.V., Pyregov A.V., Strelnikova E.V., Vinitsky A.A., Korolev A.Yu. Infusion-transfusion therapy during cesarean section in pregnant women with placenta increta. Akusherstvo i Ginekologiya/Obstetrics and Gynecology. 2017; (12): 38-44. (in Russian)
https://dx.doi.org/10.18565/aig.2017.12.38-44
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