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Query: UMLS:C0012739 (disseminated intravascular coagulation)
 8,673 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

We present a study of fibrinogen levels in 133 patients who were prone to develop disseminated intravascular coagulation as a result of an underlying complication of pregnancy such as abruptio placentae, pregnancy-induced hypertension, missed abortion, septic abortion, intrauterine fetal death, vesicular mole and amniotic fluid embolism. A high incidence of hypofibrinogenemia was found in cases of abruptio placentae (43.9%) and pregnancy-induced hypertension (25%). Hypofibrinogenemia occurred in 10% cases of intrauterine fetal death within 4 weeks of fetal demise. The use of this simple investigation makes possible the diagnosis of hemostatic failure and also helps to guide replacement therapy during the fibrinopenic state. There were 4 maternal deaths and 12 perinatal losses in this study.
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PMID:Relevance of plasma fibrinogen estimation in obstetric complications. 130 90

The HELLP syndrome (haemolysis, elevated liver enzymes, low platelet count) was first referred to by Weinstein in 1982 as an extremely progressive form of gestosis. In addition to the more common gestotic symptoms, such as oedema, proteinuria and hypertension, the clinical picture is characterized by microangiopathic haemolysis, thrombocytopenia and, especially, impaired hepatic function. Within this clinical picture severe complications can occur, such as eclamptic attacks, renal dysfunction, intracranial haemorrhage, intrahepatic haemorrhage and coagulopathy. An imbalance in prostanoid metabolism has been implicated in the pathogenesis. A decrease in synthesis of the vasodilator and thrombocyte aggregation inhibitor prostacyclin leads to a preponderance of the vasoconstrictor thromboxane A2, which promotes thrombocyte aggregation. This results in local vascular spasms and endothelial lesions, which in the case of hypercoagulopathy are accompanied by the formation of fibrin deposits with resultant vascular constriction. Intravascular fibrin deposits indicate that the coagulation system has been compromised and can lead to consumption coagulopathy in approximately 10% of cases. In the majority of cases, however, one finds low-grade disseminated intravascular coagulation (DIC), i.e. mild hypercoagulopathy with thrombocytopenia, a tendency to thrombocyte aggregation and fibrinogen deficiency in the presence of usually normal plasmatic coagulation. These vascular changes occur particularly in organs that have high blood flow, such as liver, kidneys and placenta. In the liver, sinusoidal obstruction causes vascular congestion, leading to an increase in intrahepatic pressure, dilatation of Glisson's capsule, development of subcapsular hepatic haematomas and hepatic rupture. Hepatic haematoma virtually always requires surgical treatment, and otherwise the patient has hardly any chance of survival. Nevertheless, mortality is around 35%.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Spontaneous liver rupture as a rare complication of the HELLP syndrome]. 149 26

Severe pregnancy induced hypertension (PIH, pre eclampsia) is a disease which is now treated in the intensive care unit rather than with sedation in a dark room. The pathophysiology is now well understood and allows for better and more effective management. This paper looks at the strict haemodynamic monitoring and management required to prevent complications such as eclampsia, DIC, HELLP syndrome, maternal and foetal death. The nurse's role in the management of severe PIH is discussed.
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PMID:The intensive care management of severe pregnancy induced hypertension. 159 5

Using natural language a computerized indexing and retrieval system was developed on a commercial database program, DATATRIEVE (Digital Equipment Corporation, Japan). Summarized anatomical diagnoses of nearly 4000 autopsy cases have been registered over a 13-year period at Tokyo Metropolitan Geriatric Hospital. There were 187,367 words in the pathological diagnoses with 4689 distinct words excluding articles, prepositions and conjunctions. 'Atrophy', 'congestion' and 'metastasis' were the most frequent words with frequencies of 4335, 3377, and 3373, respectively. Distinct clinical diagnoses were 2497, among which 'pneumonia', 'hypertension' and 'DIC' predominated. Each step of retrieval by character strings from the sequential data file requires less than a minute.
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PMID:A pathology database system for autopsy diagnoses using free-text method. 164 Jul 74

To examine the role of endothelin (ET) in the maternal and fetal circulation, the levels of endothelin-1-like immunoreactivity (ET-1-LI) in the plasma of maternal vein (MV), umbilical vein (UV), and umbilical artery (UA) were determined by a sensitive radioimmunoassay (RIA). Levels of ET-1-LI in MV did not show any significant change (9.9 +/- 1.5 pg/ml, n = 26) throughout normal pregnancy and were similar to those of normal nonpregnant women (10.7 +/- 2.5 pg/ml, n = 5). Levels of ET-1-LI in UV and UA obtained at normal deliveries at term were about three times higher than those in MV. In the patients with mild and severe pre-eclampsia, the levels of plasma ET-1-LI were significantly higher than those of normal pregnancy (14.3 +/- 2.2 pg/ml, n = 5 and 27.2 +/- 8.6 pg/ml, n = 5, respectively). However, in pregnant women with chronic hypertension, the levels of ET-1-LI did not increase when the hypertension did not worsen during pregnancy (11.4 +/- 1.6 pg/ml, n = 7). Moreover, in two pregnant women with abnormally stimulated coagulation, such as acute or subacute DIC, the levels of ET-1-LI were extremely high and returned gradually to those of normal nonpregnant women after the coagulation was normalized by treatment. These results suggest the possibility that ET-1 plays an important role in the pathophysiology of preeclampsia.
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PMID:Concentrations of endothelin-1 in maternal and umbilical cord blood at various stages of pregnancy. 172 7

The origin of pre-eclampsia lies in uteroplacental ischemia due to an anomaly of the "vascular insertion" of the placenta. Although the cause of this anomaly remains unknown, it would appear to include both a genetic and an immunological origin possibly favourised by special underlying conditions and certain obstetric circumstances. Prostaglandin imbalance (in particular prostacyclins and Thromboxane A2) appears to be one of the chief factors governing these anomalies. One of the consequences of these mechanisms is the onset of hypertension but other disturbances are essential features. In particular, disseminated intravascular coagulation may occur leading to the release of numerous microthrombi which cause placental (leading to chronic fetal distress), renal, hepatic and cerebral lesions.
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PMID:[Physiopathological elements of pre-eclampsia and the role of the main complementary tests]. 176 67

Pregnancies complicated by hypertensive disorders are always extremely hazardous for mother and child. In up to 30% of pregnant women this disease is characterized by feto-maternal dysfunction, looking like a kind of "chronic anaphylactoid reaction". As a result of defective genetic control, immunologic events seem to be the central etiologic aspect. Arteriolar vasospasm, pathology of platelets, disseminated intravascular coagulation and finally, elevation of maternal blood pressure, all these symptoms can be regarded as a reaction to immunologic processes. The central role of eicosanoids in the pathogenesis of pregnancy induced hypertension/preeclampsia-eclampsia is generally accepted. We can explain almost all known pathophysiologic abnormalities to be the consequence of disturbed eicosanoid production in a multitude of organs or organ systems. Defective placentation provokes poorly perfused placental tissue. This is correlated with endothelial cell disorder, endothelial damage and denudation. The resulting platelet activation, dysfunction of coagulation and vasoconstriction are due to an increased ratio between vasoconstricting and vasodilating eicosanoids. The suppression of prostacyclin (and PGE) formation in the fetal-placental-maternal unit even before the clinical manifestation of the disease seems to be the conditio sine qua non. So, the homeostatic response to the effects of vasoconstrictors (such as angiotensin, serotonin etc.) in the general and in the placental circulation is impaired. The depressed prostacyclin (and PGE) biosynthesis can be measured in urine. Altered urinary metabolite excretion appears to be a very early index for patients at risk to develop pregnancy-induced hypertension.
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PMID:Hypertensive disorders in pregnancy. The role of eicosanoids. 177 85

At the Kiel University Department of Gynaecology, 21 patients between the 21th and 39th week of gestation were treated in 1987 and 1988 following diagnosis of HELLP syndrome. At the time of diagnosis all patients presented an advanced gestosis/eclampsia. 9 patients developed the classical signs and symptoms, while hospitalised. The typical signs of gestosis, hypertension, proteinurea, oedema and hypoproteinaemia preceded the changes in laboratory values caused by the HELLP syndrome. Upper abdominal pain and increase in transaminase values occurred on the average 3.4 or 2.7 days prior to the decrease of, thrombocyte count. In 19 of the 21 cases, pregnancy was terminated by caesarean section. Severe peripartal complications occurred in 7 cases e.g. foetal death in utero (n = 3), eclampsia (n = 5), renal failure (n = 2), cerebral oedema (n = 1), intracerebral haemorrhage (n = 1), disseminated intravascular coagulation (n = 1), abdominal wall haematoma (n = 1). 6 of these patients were admitted after complications had occurred prior to admittance. All 18 infants born alive survived the neonatal period. The average birth weight was 1,571 g. 11 infants were discharged clinically normal. The remaining infants included 5 cases pointing to retinopathy and 3 cases of cerebral palsy. One infant developed post-haemorrhagic hydrocephalus.
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PMID:[Development of symptoms and perinatal complications in HELLP syndrome]. 177 22

Physicians analyzed 1983-88 data on 99 maternal deaths in the netherlands to examine causes of death and to what degree substandard care contributed to the deaths. 65 cases were classified as direct maternal deaths, 14 ad indirect maternal deaths, and 20 as fortuitous maternal deaths. They did not include the 20 fortuitous deaths in the maternal mortality rate which stood at 8.8/100,000 live births. The physicians knew all the details in 66 maternal deaths. They identified substandard factors in 57% of these cases. Most of the cases associated with substandard care were women with pregnancy induced hypertension (eclampsia). The substandard care factors included patient or physician's delay, wrong diagnosis, insufficient knowledge of proper treatment, operating without knowledge of clotting disorders, interventions on patients in an unstable condition, inadequate postpartum and postoperative surveillance, and lack of organization. The leading direct cause of maternal death was eclampsia (34%) then thromboembolism (21%), and obstetric hemorrhage (19%). 41% of the women who died from eclampsia also suffered from cerebrovascular hemorrhage. Only 2 women died from septic abortion. The major indirect cause of maternal death was cerebrovascular hemorrhage (57%). Among the direct maternal deaths, 52% had disseminated intravascular coagulation and 25% had a cesarean section. As recently as 1935 in developed countries, puerperal sepsis was the leading cause of maternal deaths (50%) then obstetrical hemorrhage and eclampsia (25%). Mortality rates began to fall with the introduction of sulphonamides and later penicillin. In developing countries, however, maternal mortality remains very high. High rates are due to high fertility and a high risk of death each time a woman is pregnant. Availability of safe contraception and elimination of illegal abortions would reduce maternal mortality considerably.
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PMID:Maternal mortality and its prevention. 180 6

Clinical and epidemiological features of 72 cases of boutonneuse fever, detected from 1979 to 1986 at the "Hospital del Insalud de Cartagena" (Murcia), are reviewed. The most important clinical features are commented on (fever, rash, tache noire), as well as the less important (dizziness, cough, conjunctivitis, sensorial changes). Several epidemiological factors were analyzed, temperature having been found to be the most significant in our area. The complications observed mainly affected patients with risk factors (senility, thrombocytopenia, hyponatremia, high blood pressure) being particularly severe in a patient who developed lethal DIC and in another 2 who developed pulmonary thromboembolism. The prophylactic measures suggested were the strict control of animals susceptible to parasites and organizing of disinfestation campaigns in the endemic areas.
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PMID:[A clinical epidemiological study of Mediterranean boutonneuse fever in the Cartagena area]. 191 50


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