Disfuncțiile multiple de organe în contextul hemoragiilor post-partum. implicații clinice și terapeutice

Abstract

Introducere. Hemoragia post-partum (HPP) reprezintă una dintre principalele cauze a morbidității materne, cu risc ma jor de deces . Scopul lucrării. Elucidarea complicațiilor HPP în lăuzia precoce. Material și metode . S-a efectuat studiu descriptiv. Examinate HPP în volum mai mare de 1000 ml la 74 parturiente, care au născut în perioada 2023-2024. Au fost analizate semnele clinice, paraclinice și de laborator. Excluse din studiu paciente cu preeclampsie severă și disfuncție de organ preexistente hemoragiei. Rezultate. Vârsta medie 21±9 ani. HPP 1000-1499 ml: 45 de cazuri (60,81%); 1500-2499ml – 26(35,14%) și ≥ 2500 ml–7 ( 9,46%). În 45 cazuri (60,81%) s-a efectuat hemostaza chirurgicală: suturi de compresiune B-Lynch–7 (15,56%) cazuri, histerectomie- 37 (84,4%) cazuri. În HPP ≥2500 ml s-a recurs la relaparatomie. Șoc hemoragic (lactat>3mmol, BE<-6mmol/L, GapPCO2>6mmHg, VO2 <150ml/min ) au manifestat 33 paciente – toate cu HPP >1500ml. AKI s-a instalat la 5 paciente (6,76%): AKI1-2cazuri, AKI2-2 si AKI3- 1caz. Disfuncția hepatică prezentă la 5 paciente, cu predominarea sindromului citolitic (ALAT-70mmol/l, ASAT-90mmol/l) - 3 cazuri. Sindromul colestatic (bilirubina > 30mmol/l) - 2 pa ciente (40%). Insuficiența respiratorie - 4 paciente (5,4%). ARDS gr1 (PaO2/FiO2-200-300) - 6 paciente. Coagulopatii - 42cazuri. Afectarea mecanismului de coagulare plasmatic 19 cazuri (45,2%): hipoprotrombinemie - 19cazuri (100%), hipofibrinogenemie <1.5g/l–12 cazuri (63,1%). Afectarea mecanismului plasmatic și plachetar 23 cazuri (54,76%). MODS 8 cazuri (10,7%). SIRS – 22 paciente: leucocitoza cu deviere spre stânga - 100%, hiperfibrinogenemie>5,5g/l-6 cazuri (27,27%), proteina „C” reactivă>23mg/l–12 cazuri (54,5%). Concluzii. HPP reprezintă o complicație obstetricală majoră care necesită eforturi substanțiale medicale și manageriale în conduita lor. Compensarea în volum deplin a HPP minimizează riscul MODS.HPP predispun la complicații puerperale și necesită antibioterapie adecvată.

Background. Postpartum hemorrhage (PPH) is one of the main causes of maternal morbidity with a major risk of death. Objective of the study. Elucidation of the complications of PPH in premature child wife. Material and methods . A de scriptive study was conducted. Examined PPH over 1000ml in 74 patients who gave birth during 2023-2024years.Clinical, paraclinical and laboratory signs were analyzed. Were excluded patients with severe preeclampsia and patients with pre-existing organ dysfunction. Results. Average age 21±9 years. HPP 1000-1499 ml-45 cases (60.81%);15002499 ml–26 cases (35.14%) and ≥ 2500 ml–7 cases (9.46%). In 45 cases (60.81%) surgical hemostasis was performed: B-Lynch compression sutures–7 cases, hysterectomy - in 37 cases. In PPH ≥2500 ml it was resorted to relaparotomy. Hemorrhagic shock (lactate>3mmol, BE <6mmol/L, GapPCO2>6mmHg, VO2<150ml/min.) was manifested by 33 patients–all with HPP >1500ml.AKI occurred in 5 patients: AKI1- 2 cases, AKI2- 2 and AKI3-1case.Liver dysfunction was detected in 5 patients, with the predominance of the cytolytic syndrome (ALT-70mmol/l, AST-90mmol/l) in 3 cases. Cholestatic syndrome (bilirubin>30mmol/l) appreciated in 2 patients (40%). Respiratory failure was presented in 4 patients. ARDS gr1 (PaO2/FiO2-200-300)–6 patients. Coagulopathy – 42 cases (56.76%). Affecting the plasmatic mechanism 19 cases (45.2%): hypoprothrombinaemia 19 cases (100%), hypofibrinogenemia <1.5g/l–12 cases (63.1%). Affecting the plasmatic and platelet mechanism 23 cases (54.76%). MODS was determined in 8 cases. SIRS – 22 patients: leukocytosis with deviation to the left22 cases, hyperfibrinogenaemia >5.5g/l-6cases, C-reactive protein>23mg/l–12 cases (54.5%). Conclusion represents a major obstetrical complication that requires substantial medical efforts and managerial in their conduct. Compensation in full volume of PPH minimizes the risk of MODS. HPP predisposes to puerperal complications and requires appropriate antibiotic therapy.