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Кровопотеря в акушерстве: главные этапы оказания помощи
Кровопотеря в акушерстве: главные этапы оказания помощи
Куликов А.В., Шифман Е.М., Беломестнов С.Р. и др. Кровопотеря в акушерстве: главные этапы оказания помощи. Гинекология. 2015; 17 (6): 22–26.
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Аннотация
В статье освещены основные этапы оказания медицинской помощи при массивной кровопотере в акушерстве: организация, оценка факторов риска, профилактика, принцип контроля за повреждением, реанимацией, контроль за гемостазом и достигаемые цели лечения. Материал основан на современных достижениях лечения массивной кровопотери в акушерстве и реальной 5-летней практике Областного перинатального центра г. Екатеринбурга. Реализация этапов оказания медицинской помощи при кровопотере в акушерстве позволит значительно снизить неблагоприятные последствия этого осложнения и обеспечить органосохраняющую тактику.
Ключевые слова: послеродовое кровотечение, интенсивная терапия, инфузионная терапия, коагулопатия, синдром диссеминированного внутрисосудистого свертывания.
Key words: postpartum hemorrhage, intensive care, infusion therapy, coagulopathy, disseminated intravascular coagulation.
Ключевые слова: послеродовое кровотечение, интенсивная терапия, инфузионная терапия, коагулопатия, синдром диссеминированного внутрисосудистого свертывания.
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Key words: postpartum hemorrhage, intensive care, infusion therapy, coagulopathy, disseminated intravascular coagulation.
Полный текст
Список литературы
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4. Ekelund K, Hanke G, Stensballe J et al. Hemostatic resuscitation in postpartum hemorrhage – a supplement to surgery. Acta Obstet Gynecol Scand 2015; 94 (7): 680–92.
5. Likis FE, Sathe NA, Morgans AK et al. Management of Postpartum Hemorrhage [Internet]. Rockville (MD): Agency for Healthcare Research and Quality (US); 2015 Apr.
6. Mousa HA, Blum J, Abou El et al. Treatment for primary postpartum haemorrhage. Cochrane Database Syst Rev 2014; 2: CD003249.
7. WHO Recommendations for the Prevention and Treatment of Postpartum Haemorrhage. Geneva: World Health Organization; 2012.
8. Приказ Минздрава России от 07.11.2012 №598н «Об утверждении стандарта специализированной медицинской помощи при кровотечении в последовом и послеродовом периоде» (зарегистрировано в Минюсте России 05.03.2013 №27501). / Prikaz Minzdrava Rossii ot 07.11.2012 №598n «Ob utverzhdenii standarta spetsializirovannoi meditsinskoi pomoshchi pri krovotechenii v posledovom i poslerodovom periode» (zaregistrirovano v Miniuste Rossii 05.03.2013 №27501). [in Russian]
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11. Shah M, Wright JD. Surgical intervention in the management of postpartum hemorrhage. Semin Perinatol 2009; 33 (2): 109–15.
12. Jin R, Guo Y, Chen Y. Risk factors associated with emergency peripartum hysterectomy. Chin Med J (Engl) 2014; 127 (5): 900–4.
13. De Lange NM, Lancé MD, de Groot R et al. Obstetric hemorrhage and coagulation: an update. Thromboelastography, thromboelastometry, and conventional coagulation tests in the diagnosis and prediction of postpartum hemorrhage. Obstet Gynecol Surv 2012; 67 (7): 426–35.
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15. Blood Transfusions in Obstetrics. Royal College of Obstetricians and Gynaecologists. Green-top Guideline No. 47. 2015.
16. Jadon A, Bagai R. Blood transfusion practices in obstetric anaesthesia. Indian J Anaesth 2014; 58 (5): 629–36.
17. Llau JV, Acosta FJ, Escolar G et al. Multidisciplinary consensus document on the management of massive haemorrhage (HEMOMAS document). Med Intensiva 2015. pii: S0210-5691(15)00113-8.
18. Callum JL, Rizoli S. Assessment and management of massive bleeding: coagulation assessment, pharmacologic strategies, and transfusion management. Hematology Am Soc Hematol Educ Program 2012; 2012: 522–8.
19. Erez O, Novack L, Beer-Weisel R et al. DIC score in pregnant women – a population based modification of the International Society on Thrombosis and Hemostasis score. PLoS One 2014; 9 (4): e93240.
20. Kobayashi T. Obstetrical disseminated intravascular coagulation score. J Obstet Gynaecol Res 2014; 40 (6): 1500–6.
21. Di Nisio M, Thachil J, Squizzato A. Management of disseminated intravascular coagulation: A survey of the International Society on Thrombosis and Haemostasis. Thromb Res 2015; 136 (2): 239–42.
22. Серов В.Н., Абубакирова А.М., Баранов И.И. Современные подходы и новые технологии при профилактике и лечении кровопотери в акушерстве. Акушерство и гинекология. 1998; 4: 44–7. / Serov V.N., Abubakirova A.M., Baranov I.I. Sovremennye podkhody i novye tekhnologii pri profilaktike i lechenii krovopoteri v akusherstve. Akusherstvo i ginekologiia. 1998; 4: 44–7. [in Russian]
23. Серов В.Н., Баранов И.И. Растворы гидроксиэтилированного крахмала в акушерско-гинекологической практике. Рус. мед. журн. 2006; 14 (1): 21–4. / Serov V.N., Baranov I.I. Rastvory gidroksietilirovannogo krakhmala v akushersko-ginekologicheskoi praktike. Rus. med. zhurn. 2006; 14 (1): 21–4. [in Russian]
2. Abdul-Kadir R, McLintock C, Ducloy AS et al. Evaluation and management of postpartum hemorrhage: consensus from an international expert panel. Transfusion 2014; 54 (7): 1756–68.
3. Dahlke JD, Mendez-Figueroa H, Maggio L et al. Prevention and management of postpartum hemorrhage: a comparison of 4 national guidelines. Am J Obstet Gynecol 2015; 213 (1): 76.e1–76.e10.
4. Ekelund K, Hanke G, Stensballe J et al. Hemostatic resuscitation in postpartum hemorrhage – a supplement to surgery. Acta Obstet Gynecol Scand 2015; 94 (7): 680–92.
5. Likis FE, Sathe NA, Morgans AK et al. Management of Postpartum Hemorrhage [Internet]. Rockville (MD): Agency for Healthcare Research and Quality (US); 2015 Apr.
6. Mousa HA, Blum J, Abou El et al. Treatment for primary postpartum haemorrhage. Cochrane Database Syst Rev 2014; 2: CD003249.
7. WHO Recommendations for the Prevention and Treatment of Postpartum Haemorrhage. Geneva: World Health Organization; 2012.
8. Prikaz Minzdrava Rossii ot 07.11.2012 №598n «Ob utverzhdenii standarta spetsializirovannoi meditsinskoi pomoshchi pri krovotechenii v posledovom i poslerodovom periode» (zaregistrirovano v Miniuste Rossii 05.03.2013 №27501). [in Russian]
9. Shifman E.M., Kulikov A.V., Belomestnov S.R. Intensivnaia terapiia i anesteziia pri krovopotere v akusherstve. Klinicheskie rekomendatsii. M.: Meditsina, 2014. [in Russian]
10. Hackethal A, Tcharchian G, Ionesi-Pasacica J et al. Uterine surgery in postpartum hemorrhage. Minerva Ginecol 2009; 61 (3): 201–13.
11. Shah M, Wright JD. Surgical intervention in the management of postpartum hemorrhage. Semin Perinatol 2009; 33 (2): 109–15.
12. Jin R, Guo Y, Chen Y. Risk factors associated with emergency peripartum hysterectomy. Chin Med J (Engl) 2014; 127 (5): 900–4.
13. De Lange NM, Lancé MD, de Groot R et al. Obstetric hemorrhage and coagulation: an update. Thromboelastography, thromboelastometry, and conventional coagulation tests in the diagnosis and prediction of postpartum hemorrhage. Obstet Gynecol Surv 2012; 67 (7): 426–35.
14. American Society of Anesthesiologists Task Force on Perioperative Blood Management. Practice guidelines for perioperative blood management: an updated report by the American Society of Anesthesiologists Task Force on Perioperative Blood Management. Anesthesiology 2015; 122 (2): 241–75.
15. Blood Transfusions in Obstetrics. Royal College of Obstetricians and Gynaecologists. Green-top Guideline No. 47. 2015.
16. Jadon A, Bagai R. Blood transfusion practices in obstetric anaesthesia. Indian J Anaesth 2014; 58 (5): 629–36.
17. Llau JV, Acosta FJ, Escolar G et al. Multidisciplinary consensus document on the management of massive haemorrhage (HEMOMAS document). Med Intensiva 2015. pii: S0210-5691(15)00113-8.
18. Callum JL, Rizoli S. Assessment and management of massive bleeding: coagulation assessment, pharmacologic strategies, and transfusion management. Hematology Am Soc Hematol Educ Program 2012; 2012: 522–8.
19. Erez O, Novack L, Beer-Weisel R et al. DIC score in pregnant women – a population based modification of the International Society on Thrombosis and Hemostasis score. PLoS One 2014; 9 (4): e93240.
20. Kobayashi T. Obstetrical disseminated intravascular coagulation score. J Obstet Gynaecol Res 2014; 40 (6): 1500–6.
21. Di Nisio M, Thachil J, Squizzato A. Management of disseminated intravascular coagulation: A survey of the International Society on Thrombosis and Haemostasis. Thromb Res 2015; 136 (2): 239–42.
22. Серов В.Н., Абубакирова А.М., Баранов И.И. Современные подходы и новые технологии при профилактике и лечении кровопотери в акушерстве. Акушерство и гинекология. 1998; 4: 44–7. / Serov V.N., Abubakirova A.M., Baranov I.I. Sovremennye podkhody i novye tekhnologii pri profilaktike i lechenii krovopoteri v akusherstve. Akusherstvo i ginekologiia. 1998; 4: 44–7. [in Russian]
23. Serov V.N., Baranov I.I. Rastvory gidroksietilirovannogo krakhmala v akushersko-ginekologicheskoi praktike. Rus. med. zhurn. 2006; 14 (1): 21–4. [in Russian]
2. Abdul-Kadir R, McLintock C, Ducloy AS et al. Evaluation and management of postpartum hemorrhage: consensus from an international expert panel. Transfusion 2014; 54 (7): 1756–68.
3. Dahlke JD, Mendez-Figueroa H, Maggio L et al. Prevention and management of postpartum hemorrhage: a comparison of 4 national guidelines. Am J Obstet Gynecol 2015; 213 (1): 76.e1–76.e10.
4. Ekelund K, Hanke G, Stensballe J et al. Hemostatic resuscitation in postpartum hemorrhage – a supplement to surgery. Acta Obstet Gynecol Scand 2015; 94 (7): 680–92.
5. Likis FE, Sathe NA, Morgans AK et al. Management of Postpartum Hemorrhage [Internet]. Rockville (MD): Agency for Healthcare Research and Quality (US); 2015 Apr.
6. Mousa HA, Blum J, Abou El et al. Treatment for primary postpartum haemorrhage. Cochrane Database Syst Rev 2014; 2: CD003249.
7. WHO Recommendations for the Prevention and Treatment of Postpartum Haemorrhage. Geneva: World Health Organization; 2012.
8. Приказ Минздрава России от 07.11.2012 №598н «Об утверждении стандарта специализированной медицинской помощи при кровотечении в последовом и послеродовом периоде» (зарегистрировано в Минюсте России 05.03.2013 №27501). / Prikaz Minzdrava Rossii ot 07.11.2012 №598n «Ob utverzhdenii standarta spetsializirovannoi meditsinskoi pomoshchi pri krovotechenii v posledovom i poslerodovom periode» (zaregistrirovano v Miniuste Rossii 05.03.2013 №27501). [in Russian]
9. Шифман Е.М., Куликов А.В., Беломестнов С.Р. Интенсивная терапия и анестезия при кровопотере в акушерстве. Клинические рекомендации. М.: Медицина, 2014. / Shifman E.M., Kulikov A.V., Belomestnov S.R. Intensivnaia terapiia i anesteziia pri krovopotere v akusherstve. Klinicheskie rekomendatsii. M.: Meditsina, 2014. [in Russian]
10. Hackethal A, Tcharchian G, Ionesi-Pasacica J et al. Uterine surgery in postpartum hemorrhage. Minerva Ginecol 2009; 61 (3): 201–13.
11. Shah M, Wright JD. Surgical intervention in the management of postpartum hemorrhage. Semin Perinatol 2009; 33 (2): 109–15.
12. Jin R, Guo Y, Chen Y. Risk factors associated with emergency peripartum hysterectomy. Chin Med J (Engl) 2014; 127 (5): 900–4.
13. De Lange NM, Lancé MD, de Groot R et al. Obstetric hemorrhage and coagulation: an update. Thromboelastography, thromboelastometry, and conventional coagulation tests in the diagnosis and prediction of postpartum hemorrhage. Obstet Gynecol Surv 2012; 67 (7): 426–35.
14. American Society of Anesthesiologists Task Force on Perioperative Blood Management. Practice guidelines for perioperative blood management: an updated report by the American Society of Anesthesiologists Task Force on Perioperative Blood Management. Anesthesiology 2015; 122 (2): 241–75.
15. Blood Transfusions in Obstetrics. Royal College of Obstetricians and Gynaecologists. Green-top Guideline No. 47. 2015.
16. Jadon A, Bagai R. Blood transfusion practices in obstetric anaesthesia. Indian J Anaesth 2014; 58 (5): 629–36.
17. Llau JV, Acosta FJ, Escolar G et al. Multidisciplinary consensus document on the management of massive haemorrhage (HEMOMAS document). Med Intensiva 2015. pii: S0210-5691(15)00113-8.
18. Callum JL, Rizoli S. Assessment and management of massive bleeding: coagulation assessment, pharmacologic strategies, and transfusion management. Hematology Am Soc Hematol Educ Program 2012; 2012: 522–8.
19. Erez O, Novack L, Beer-Weisel R et al. DIC score in pregnant women – a population based modification of the International Society on Thrombosis and Hemostasis score. PLoS One 2014; 9 (4): e93240.
20. Kobayashi T. Obstetrical disseminated intravascular coagulation score. J Obstet Gynaecol Res 2014; 40 (6): 1500–6.
21. Di Nisio M, Thachil J, Squizzato A. Management of disseminated intravascular coagulation: A survey of the International Society on Thrombosis and Haemostasis. Thromb Res 2015; 136 (2): 239–42.
22. Серов В.Н., Абубакирова А.М., Баранов И.И. Современные подходы и новые технологии при профилактике и лечении кровопотери в акушерстве. Акушерство и гинекология. 1998; 4: 44–7. / Serov V.N., Abubakirova A.M., Baranov I.I. Sovremennye podkhody i novye tekhnologii pri profilaktike i lechenii krovopoteri v akusherstve. Akusherstvo i ginekologiia. 1998; 4: 44–7. [in Russian]
23. Серов В.Н., Баранов И.И. Растворы гидроксиэтилированного крахмала в акушерско-гинекологической практике. Рус. мед. журн. 2006; 14 (1): 21–4. / Serov V.N., Baranov I.I. Rastvory gidroksietilirovannogo krakhmala v akushersko-ginekologicheskoi praktike. Rus. med. zhurn. 2006; 14 (1): 21–4. [in Russian]
________________________________________________
2. Abdul-Kadir R, McLintock C, Ducloy AS et al. Evaluation and management of postpartum hemorrhage: consensus from an international expert panel. Transfusion 2014; 54 (7): 1756–68.
3. Dahlke JD, Mendez-Figueroa H, Maggio L et al. Prevention and management of postpartum hemorrhage: a comparison of 4 national guidelines. Am J Obstet Gynecol 2015; 213 (1): 76.e1–76.e10.
4. Ekelund K, Hanke G, Stensballe J et al. Hemostatic resuscitation in postpartum hemorrhage – a supplement to surgery. Acta Obstet Gynecol Scand 2015; 94 (7): 680–92.
5. Likis FE, Sathe NA, Morgans AK et al. Management of Postpartum Hemorrhage [Internet]. Rockville (MD): Agency for Healthcare Research and Quality (US); 2015 Apr.
6. Mousa HA, Blum J, Abou El et al. Treatment for primary postpartum haemorrhage. Cochrane Database Syst Rev 2014; 2: CD003249.
7. WHO Recommendations for the Prevention and Treatment of Postpartum Haemorrhage. Geneva: World Health Organization; 2012.
8. Prikaz Minzdrava Rossii ot 07.11.2012 №598n «Ob utverzhdenii standarta spetsializirovannoi meditsinskoi pomoshchi pri krovotechenii v posledovom i poslerodovom periode» (zaregistrirovano v Miniuste Rossii 05.03.2013 №27501). [in Russian]
9. Shifman E.M., Kulikov A.V., Belomestnov S.R. Intensivnaia terapiia i anesteziia pri krovopotere v akusherstve. Klinicheskie rekomendatsii. M.: Meditsina, 2014. [in Russian]
10. Hackethal A, Tcharchian G, Ionesi-Pasacica J et al. Uterine surgery in postpartum hemorrhage. Minerva Ginecol 2009; 61 (3): 201–13.
11. Shah M, Wright JD. Surgical intervention in the management of postpartum hemorrhage. Semin Perinatol 2009; 33 (2): 109–15.
12. Jin R, Guo Y, Chen Y. Risk factors associated with emergency peripartum hysterectomy. Chin Med J (Engl) 2014; 127 (5): 900–4.
13. De Lange NM, Lancé MD, de Groot R et al. Obstetric hemorrhage and coagulation: an update. Thromboelastography, thromboelastometry, and conventional coagulation tests in the diagnosis and prediction of postpartum hemorrhage. Obstet Gynecol Surv 2012; 67 (7): 426–35.
14. American Society of Anesthesiologists Task Force on Perioperative Blood Management. Practice guidelines for perioperative blood management: an updated report by the American Society of Anesthesiologists Task Force on Perioperative Blood Management. Anesthesiology 2015; 122 (2): 241–75.
15. Blood Transfusions in Obstetrics. Royal College of Obstetricians and Gynaecologists. Green-top Guideline No. 47. 2015.
16. Jadon A, Bagai R. Blood transfusion practices in obstetric anaesthesia. Indian J Anaesth 2014; 58 (5): 629–36.
17. Llau JV, Acosta FJ, Escolar G et al. Multidisciplinary consensus document on the management of massive haemorrhage (HEMOMAS document). Med Intensiva 2015. pii: S0210-5691(15)00113-8.
18. Callum JL, Rizoli S. Assessment and management of massive bleeding: coagulation assessment, pharmacologic strategies, and transfusion management. Hematology Am Soc Hematol Educ Program 2012; 2012: 522–8.
19. Erez O, Novack L, Beer-Weisel R et al. DIC score in pregnant women – a population based modification of the International Society on Thrombosis and Hemostasis score. PLoS One 2014; 9 (4): e93240.
20. Kobayashi T. Obstetrical disseminated intravascular coagulation score. J Obstet Gynaecol Res 2014; 40 (6): 1500–6.
21. Di Nisio M, Thachil J, Squizzato A. Management of disseminated intravascular coagulation: A survey of the International Society on Thrombosis and Haemostasis. Thromb Res 2015; 136 (2): 239–42.
22. Серов В.Н., Абубакирова А.М., Баранов И.И. Современные подходы и новые технологии при профилактике и лечении кровопотери в акушерстве. Акушерство и гинекология. 1998; 4: 44–7. / Serov V.N., Abubakirova A.M., Baranov I.I. Sovremennye podkhody i novye tekhnologii pri profilaktike i lechenii krovopoteri v akusherstve. Akusherstvo i ginekologiia. 1998; 4: 44–7. [in Russian]
23. Serov V.N., Baranov I.I. Rastvory gidroksietilirovannogo krakhmala v akushersko-ginekologicheskoi praktike. Rus. med. zhurn. 2006; 14 (1): 21–4. [in Russian]
Авторы
А.В.Куликов*1, Е.М.Шифман2, С.Р.Беломестнов3, А.В.Жилин3, А.А.Матковский3, А.С.Быков3, С.Г.Абабков3
1. ГБОУ ВПО Уральский государственный медицинский университет Минздрава России. 620028, Россия, Екатеринбург, ул. Репина, д. 3;
2. ГБУЗ МО Московский областной научно-исследовательский клинический институт им. М.Ф.Владимирского. 129110, Россия, Москва, ул. Щепкина, д. 61/2;
3. ГБУЗ СО Областная детская клиническая больница №1. 620149, Россия, Екатеринбург, ул. Серафимы Дерябиной, д. 32
*kulikov1905@yandex.ru
1. Ural State Medical University of the Ministry of Health of the Russian Federation. 620028, Russian Federation, Yekaterinburg, ul. Repina, d. 3;
2. M.F.Vladimirskiy Moscow Regional Research Clinical Institute. 129110, Russian Federation, Moscow, ul. Shchepkina, d. 61/2;
3. Sverdlovsk Regional Children Clinical Hospital. 620149, Russian Federation, Yekaterinburg, ul. Serafimy Deriabinoi, d. 32
*kulikov1905@yandex.ru
1. ГБОУ ВПО Уральский государственный медицинский университет Минздрава России. 620028, Россия, Екатеринбург, ул. Репина, д. 3;
2. ГБУЗ МО Московский областной научно-исследовательский клинический институт им. М.Ф.Владимирского. 129110, Россия, Москва, ул. Щепкина, д. 61/2;
3. ГБУЗ СО Областная детская клиническая больница №1. 620149, Россия, Екатеринбург, ул. Серафимы Дерябиной, д. 32
*kulikov1905@yandex.ru
________________________________________________
1. Ural State Medical University of the Ministry of Health of the Russian Federation. 620028, Russian Federation, Yekaterinburg, ul. Repina, d. 3;
2. M.F.Vladimirskiy Moscow Regional Research Clinical Institute. 129110, Russian Federation, Moscow, ul. Shchepkina, d. 61/2;
3. Sverdlovsk Regional Children Clinical Hospital. 620149, Russian Federation, Yekaterinburg, ul. Serafimy Deriabinoi, d. 32
*kulikov1905@yandex.ru
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