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Vol 16, No 1 (2023)
Review paper
Published online: 2023-03-08

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Przywracanie hemostazy w ciężkim krwotoku poporodowym — algorytm 2023

Elżbieta Nowacka1
Journal of Transfusion Medicine 2023;16(1):12-22.

Abstract

Krwotok poporodowy (PPH) nadal pozostaje najczęstszą przyczyną okołoporodowych zgonów
kobiet w wieku rozrodczym. Cechuje się dużą dynamiką, a najwięcej kobiet umiera w ciągu
pierwszej doby połogu i aż 88% z nich w pierwszych 4 godzinach od momentu jego wystąpienia.
Postępowanie w każdym masywnym krwotoku położniczym powinno być interdyscyplinarne,
zespołowe i wielokierunkowe. Należy podkreślić konieczność jednoczesnego stosowania środków
uterotonicznych, metod chirurgicznych i/lub wewnątrznaczyniowych oraz postępowania
nakierowanego na przywracanie wolemii i hemostazy. Protokół leczenia ciężkiego PPH należy
nakierować na daną pacjentkę i uwzględniać etiologię krwotoku. Wymaga to każdorazowo
zdefiniowania objętości krwi krążącej, stopnia jej utraty, wdrożenia adekwatnego do utraty
postępowania oraz wyznaczenia punktów początkowych, od których rozpoczyna się agresywne
leczenie, oraz punktów końcowych, które dają efekt satysfakcjonujący. Najczęstszą przyczyną
ciężkiego, zagrażającego życiu PPH, jest atonia macicy. Przywracanie hemostazy w masywnym
PPH polega na toczeniu składników krwi, podaży leków hamujących fibrynolizę, koncentratów
czynników krzepnięcia, w tym rFVIIa. O przeżyciu pacjentki często decyduje sama świadomość
ryzyka wystąpienia krwotoku, wczesne rozpoznanie i szybkie wdrożenie algorytmów leczenia
PPH.

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