During pregnancy, the body undergoes various physiological changes as it adapts to the role of developing a fetus. During this fragile time period, a mother’s body is susceptible to various medical conditions that she may otherwise not be at risk for at any other period in her life. The most common cause of abnormal hemorrhage during pregnancy, and in the puerperium, is the thrombohemorrhagic disorder disseminated intravascular coagulation, or DIC. DIC occurs secondary to an underlying condition, often undetected by the time that manifestations of DIC are apparent. Diagnosis of precipitating factors is imperative to preventing the development of DIC and prevention through vigilant, attentive medical care and treatment of associated disorders …show more content…
Normally fibrin, the primary protein involved in clot formation, functions under the influence of regulatory mechanisms such as the anticoagulant protein antithrombin III and the enzyme plasmin, which is involved in the breakdown of clot formation in a process known as fibrinolysis (Levi, 2013). As the body’s regulation of clot formation and disintegration becomes disrupted in DIC, micro thrombi development and uncontrolled bleeding due to consumption coagulopathy, a lack of available clotting factors in the blood, occur which is a life threatening …show more content…
Abruptio placenta, amniotic fluid embolism and retention of fetal or placental material are significant factors that may lead to DIC. The placenta and amniotic fluid are plentiful sources of Tissue Factor, a protein responsible for the initiation of coagulation in the blood, and these complications can cause high levels of tissue factor to enter the bloodstream, activating coagulation mechanisms and causing DIC (Levi, 2013). Although there are no lab tests available specifically for the diagnosis of DIC, there are a number of significant lab value deviations that correlate with the impending development of DIC. According to Pillitteri
We can organize information regarding this case study by using the Four Topics Method beginning with the Medical Indications. Maria, a 20-year-old female, has been involved in a motor vehicle accident. She has a history of Sickle Cell disease and is currently twenty-five weeks pregnant with her first child. Initially Maria presents with somewhat stable vital signs. She displays tachypnea, and complains of severe abdominal cramping as well as weakness, light-headedness and left shoulder pain. She is neurologically intact with lung sounds that are within defined parameters. Maria’s condition changes and she begins to display signs and symptoms of internal bleeding. This is a life threatening condition. The problem is critical and can be reversed with a transfusion and surgery. The goal of transfusion would be to replace blood loss and restore vascular volume and the goal of surgery would be to repair the bleed. If the bleed is corrected in a timely manner and without complication, the probabilities of success are somewhat high. There is no plan in place to account for therapeutic failure. Medical care in this instance could not only save the life of this patient but also that of her unborn child. Further harm to Maria and her baby could be avoided if she would agree to the treatment.
In septic patients, increased levels of PAI-1 inhibit plasminogen activator (t-PA), which converts plasminogen to plasmin. Release of fibrin inhibits fibrinolysis by activation of thrombin-activatable fibrinolysis inhibitor (TAFI). In addition, the release of PAF causes platelet aggregation. This combination of inhibition of fibrinolysis, fibrin strand production and platelet aggregation contribute to a state of coagulopathy. This can lead to microcirculatory dysfunction with isolated or multiple organ dysfunction and cell death. Mr Hertz’s coagulation profile showed a fibrinogen level of 5.6 g/L, indicating that coagulopathies were underway in his system.
In some individuals with severe hemophilia, the factor VIII replacement therapy is identified as a foreign substance by their immune system. If this happens, their immune system will make antibodies against factor VIII. These antibodies will inhibit the ability of the factor to work in the clotting process. The higher the antibody or inhibitor level, the more factor VIII replacement therapy it takes to overcome the inhibition and produce clotting. This can complicate the treatment of a bleed. The good news is that there are different types of therapies available to successfully treat most individuals who develop inhibitors.
A literature search was conducted using EMBASE database (1980 to 2014 Week 06) and MEDLINE database (1946 to February Week 2 2014) accessed through Ovid. The databases were accessed on February 8, 2014. Keywords included dabigatran etexilate, warfarin, thrombosis, and...
To stop the blood flow after damage, the body uses three ways to maintain hemostasis: vascular spasm, platelet plug formation, and coagulation. Coagulation is an important process to prevent loss of blood when blood vessels are cut or damaged. Blood clot is a platelet plug reinforced with the mesh of fibrin. However, in a person with disseminated intravascular coagulation, DIC, the blood clots have formed throughout the blood vessels when not necessary. It leads to organ damage due to blocked blood vessels; furthermore, it leads to life-threatening bleeding due to wasting clotting factors and platelets when they are needed.
Hemophilia is the oldest know, lifelong bleeding disorder(“Hemophilia”2004). It is named for two inherited diseases in which the blood does not clot normally. Several different plasma proteins must be present for blood to clot property. If one of the plasma proteins is missing, or present at low levels, blood clots very slowly(“Hemophilia” The Marshall Cavendish). The two most common types of hemophilia are: Hemophilia A or FactorVIII(8) deficiency and Hemophilia B of FactorIX(9) deficiency(“Hemophilia” 2002). People with Hemophilia A have low levels of one kind of blood clotting protein and people with Hemophilia B have low levels of another kind(“Hemophilia” The new book).
In a healthy human being, the body is able to prevent excessive bleeding. This prevention occurs through the action of plasma and this specific action causes the plasma to become sticky and form clots. Clots are composed at the place where the injury occurs to stop excessive bleeding due to possible wounds in the area and potentially causing death. Clotting takes place naturally and it relies on many chemical reactions occurring in the body so a substance called thrombin can be produced. However blood clots can also form abnormally and this is not common in a healthy person. When blood clots, without the need of it to then this can cause a heart attack or a stroke. Most heart attacks occur due to the formation of a blood clot on the cholesterol plaque inside an artery in the heart or even the brain. When the plaque bursts, thrombogenic substances are exposed to blood which therefore triggers the blood clotting mechanism (WebMD). This is where the use of anticoagulants comes in. Anticoagulants are medicines that reduce blood clotting in an artery, a vein or the heart. They can also prevent existing clots from getting bigger as this would prevent any further blockages. There are many different types of anticoagulants but the three main ones that I am going to explore in this report are Warfarin, Enoxaparin and Apixaban.
Postpartum hemorrhage is the leading cause of maternal mortality in the world, according to the World Health Organization. Postpartum hemorrhage (PPH) is generally defined as a blood loss of more than 500 mL after a vaginal birth, more than 1000 mL after a cesarean section, and a ten percent decrease in hematocrit levels from pre to post birth measurements (Ward & Hisley, 2011). An early hemorrhage occurs within 24 hours of birth, with the greatest risk in the first four hours. A late hemorrhage happens after 24 hours of birth but less than six weeks after birth. Uterine atony—failure for the uterine myometrium to contract—is the most common postpartum hemorrhage (Venes, Ed.).(2013). Other etiologies include lower genital tract lacerations, uterine inversion, retained products of conception and bleeding disorders (Kawamura, Kondoh, Hamanishi, Kawasaki, & Fujita, (2014).
Any event during her pregnancy, labour or birth that may lead to the mixing of maternal and fetal blood, also known as sensitising events, This event has many repercussions for the fetus including anaemia due to the destruction of RBCs, Haemolytic disease of the newborn (HDN), oedema, congestive heart failure, neurological damage, jaundice due to increased levels of bilirubin, kernicterus, hydrops fetalia, ictarus gravis neonatorum, fetal death interutero and stillbirth. (Collins. S et al. 2013; Stables. D & Rankin. J 2014).
The most common causes of PPH are uterine atony, retained placenta, and lacerations. Additional causes include coagulation defects, uterine inversion, and hematomas. Uterine atony, which is the inability of the uterine muscles to contract, is responsible for about 70% of cases (Oberg et al., 2014). Without the contraction of the uterus, significant blood loss can occur from the area of placenta separation (simpson & Creehan, 2014). Understanding the etiology and risk factors of PPH can help nurses improve outcomes through early recognition of
Patients that are taking anticoagulant should report the following to their doctor: bleeding gums, blisters/bruises, and a consistent headache that doesn’t improve with analgesics or NSAIDs. This signs and symptoms can indicate things such as: the patient might be receiving too much anticoagulants or patient might be taking aspirins along with anticoagulants that the doctor probably didn’t suggest. However, if the patient is receiving too much anticoagulant, it always important that antidotes for heparin like Protamine Sulfate and warfarin such as: Vitamin K be readily available. Safety for the patient is priority. Patients who are pregnant or might be breastfeeding are instructed not to take anticoagulants also because it increases their chances of bleeding. If the patient may have any other conditions such as: heart failure, congested heart failure, kidney failure, and liver dysfunction; it should be reported to the doctor because the doctor might have to prescribe something that will be more effective in ensure that they patient gets the right medication and
Here I will discuss evidence surrounding the notion of “once a caesarean, always caesarean” and the current practise guideline. According to Uptodate, the 1960s research in support of “once a caesarean, always caesarean” has since been contradicted.
“ Sepsis” according to the International Surviving Sepsis Campaign, is defined as the presence of infection together with systemic manifestations of infection (Dellinger et al., 2013) In todays modern society sepsis still accounts for 15% of maternal deaths a year worldwide (Dolea & Stein, 2003). Despite medical advances, aseptic technique, and antibiotic use, sepsis is the most common cause of direct maternal death in the UK. According to the CMACE report the maternal mortality rate increased from 0.85 deaths per 100,000 maternities in 2003–05 to 1.13 deaths in 2006–08 (Harper, 2011). Puerperal sepsis has a long history within obstetrics and midwifery, and yet despite this knowledge it has become, yet again, the leading cause of direct maternal death. Therefore due to the increased maternal mortality, I have chosen to focus on the care of a woman within ...
If a pregnant female came into the ER and had a CBC ran showing a low platelets count,
Although childbirth appears to be a calm and unforgettable moment for mothers and family members, there can be severe complications that can affect not only the mother, but also the delivery and the child; on the contrary, the process may also run smoothly without any