scholarly journals P20.07: The case for ultrasound guidance when introducing an intrauterine balloon to arrest uterine haemorrhage

2012 ◽  
Vol 40 (S1) ◽  
pp. 250-250 ◽  
Author(s):  
S. D. Visvanathan ◽  
B. Dawlatly ◽  
R. Kuppusamy ◽  
K. Arambage ◽  
N. D. Deo
Keyword(s):  
Ultrasound Guidance ◽  
Uterine Haemorrhage

Placental Transfer of Vitamin K1 and Its Implications in Fetal Hemostasis

1988 ◽  
Vol 60 (01) ◽  
pp. 039-043 ◽  
Author(s):  
L Mandelbrot ◽  
M Guillaumont ◽  
M Leclercq ◽  
J J Lefrère ◽  
D Gozin ◽  
...  
Keyword(s):  
Vitamin K ◽  
High Performance ◽  
Ultrasound Guidance ◽  
Placental Transfer ◽  
Vitamin K1 ◽  
Vitamin K Deficiency ◽  
Prothrombin Activity ◽  
Oral Supplementation ◽  
K Deficiency ◽  
The Mean

SummaryVitamin K status was evaluated using coagulation studies and/ or vitamin IQ assays in a total of 53 normal fetuses and 47 neonates. Second trimester fetal blood samples were obtained for prenatal diagnosis under ultrasound guidance. Endogenous vitamin K1 concentrations (determined by high performance liquid chromatography) were substantially lower than maternal levels. The mean maternal-fetal gradient was 14-fold at mid trimester and 18-fold at birth. Despite low vitamin K levels, descarboxy prothrombin, detected by a staphylocoagulase assay, was elevated in only a single fetus and a single neonate.After maternal oral supplementation with vitamin K1, cord vitamin K1 levels were boosted 30-fold at mid trimester and 60 fold at term, demonstrating placental transfer. However, these levels were substantially lower than corresponding supplemented maternal levels. Despite elevated vitamin K1 concentrations, supplemented fetuses and neonates showed no increase in total or coagulant prothrombin activity. These results suggest that the low prothrombin levels found during intrauterine life are not due to vitamin K deficiency.

Fibrinolysis in Obstetrical Coagulopathy

1961 ◽  
Vol 05 (01) ◽  
pp. 021-037 ◽  
Author(s):  
H Zilliacus
Keyword(s):  
Coagulation Factors ◽  
Clotting Factor ◽  
Foetal Death ◽  
Dilution Technique ◽  
Induced Labor ◽  
Blood Samples ◽  
Decidual Tissue ◽  
Obstetrics And Gynaecology ◽  
Obstetrical Management ◽  
Uterine Haemorrhage

SummaryIn the introduction it is stressed that in cases with normal blood coagulation and even in cases with a limited decrease of some of the coagulation factors, the contraction of the uterus after the passage of the placenta closes the vessel endings, thereby providing the conditions necessary for haemostasis through the clotting of the blood. In contrast to this, fibrinolytic uterine bleeding is a condition in which the clotting factor and clot are consumed despite adequate postpartum contraction of the uterus.The literature on obstetrical coagulopathies is briefly summarized.The incongruence in the clotting power of blood samples drawn simultaneously from a cubital vein and from the uterus in cases of severe uterine haemorrhage is pointed out.With the aid of a plasma-dilution technique (Schneider) for the estimation of fibrinogen and fibrinolysis it was shown that in 6 out of 8 investigated cases of premature separation of the placenta, in 4 out of 5 observed cases of longstanding intrauterine foetal death and in 2 cases of pitocin drip induced labor considerable fibrinolytic activity was present in the blood from the uterus, whereas only slight activity if any, could be observed in blood samples drawn simultaneously from a cubital vein. These observations are found to be in conformity with the finding of considerable amounts of fibrinolytic activators in myométrial, placental and decidual tissue reported by other authors.Figures for obstetrical cases (19,808 deliveries) and uterine haemorrhage during the 5-year period 1955—1959 at the 1st Department of Obstetrics and Gynaecology, University Central Hospital, Helsinki, Finland, are presented. The main principles of obstetrical management at this hospital are outlined, with special reference to uterine coagulopathic haemorrhage.

AORTA Registry 7F vs 11-12 F access

2019 ◽  
Vol 3 (1) ◽  
Author(s):  
Reviewer Joseph DuBose ◽  
Jonathan Morrison ◽  
Megan Brenner ◽  
Laura Moore ◽  
John B Holcomb ◽  
...  
Keyword(s):  
Ultrasound Guidance ◽  
Balloon Occlusion ◽  
Aortic Occlusion ◽  
Severely Injured ◽  
Distal Extremity ◽  
Low Profile ◽  
Transfusion Requirements ◽  
Thrombotic Complications ◽  
Device Use ◽  
Endovascular Balloon Occlusion

ABSTRACT Introduction:  The introduction of low profile devices designed for Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) after trauma has the potential to change practice, outcomes and complication profiles related to this procedure. Methods: The AAST Aortic Occlusion for Resuscitation in Trauma and Acute Care Surgery (AORTA) registry was utilized to identify REBOA patients from 16 centers -comparing presentation, intervention and outcome variables for those REBOA via traditional 11-12 access platforms and trauma-specific devices requiring only 7 F access. Results:From Nov 2013-Dec 2017, 242 patients with completed data were identified, constituting 124 7F and 118 11-12F uses. Demographics of presentation were not different between the two groups, except that the 7F patients had a higher mean ISS (39.2 34.1, p = 0.028). 7F device use was associated with a lower cut-down requirement for access (22.6% vs. 37.3%, p = 0.049) and increased ultrasound guidance utilization (29.0% 23.7%, p = 0.049). 7F device afforded earlier aortic occlusion in the course of resuscitation (median 25.0 mins vs. 30 mins, p = 0.010), and had lower median PRBC (10.0 vs. 15.5 units, p = 0.006) and FFP requirements (7.5 vs. 14.0 units, p = 0.005). 7F patients were more likely to survive 24 hrs (58.1% vs. 42.4%, p = 0.015) and less likely to suffer in-hospital mortality (57.3% vs. 75.4%, p = 0.003). Finally, 7F device use was associated with a 4X lower rate of distal extremity embolism (20.0% vs. 5.6%, p = 0.014;OR 95% CI 4.25 [1.25-14.45]) compared to 11-12F counterparts. Conclusion: The introduction of trauma specific 7F REBOA devices appears to have influenced REBOA practices, with earlier utilization in severely injured hypotensive patients via less invasive means that are associated with lower transfusion requirements fewer thrombotic complications and improved survival. Additional study is required to determine optimal REBOA utilization.

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