Coagulopatia & embarazo
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Transcript of Coagulopatia & embarazo
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Coagulopatía Adquirida & Embarazo
Ancizar De La Peña Silva
Anestesiología y Reanimación
Previniendo una Catástrofe
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NUEVA TEORIA DE LA COAGULACION
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Hoffman M, Monroe DM: Coagulation 2006: a modern view of hemostasis. Hematol Oncol Clin North Am 2007; 21: 1
INICIACION
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Hoffman M, Monroe DM: Coagulation 2006: a modern view of hemostasis. Hematol Oncol Clin North Am 2007; 21: 1
AMPLIFICACION
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Hoffman M, Monroe DM: Coagulation 2006: a modern view of hemostasis. Hematol Oncol Clin North Am 2007; 21: 1
PROPAGACION
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Factores de CoagulaciónFibrinógeno
FibrinólisisIPA 1
Anticoagulantes
Prot. C y SHipercoagulable
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Cambios en los Factores de Coagulación
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Disseminated intravascular coagulation in obstetric disorders and its acute haematological management. Blood Reviews 23 (2009) 167–176
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Todo Fríamente Calculado..!
PREVIENDO EL SANGRADO
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ETILOGIACOMUNES
Hemorragia Masiva
Abrupcio Placentae
Preclampsia Severa/HELL
P
RARAS
Sepsis
Hígado Graso Agudo
Embolismo Liquido
Amniótico
Reacciones Transfusional
es
Enfermedad Autoinmune
Feto Muerto retenido
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Hemorragia Obstétrica Masiva
Inadecuada Reanimación Hídrica
Vasoespamos Lesión Endotelial
Hipotensión Hipo perfusión acidosis
Liberación de Citoquinas
Hemodilución
Disminución de Factores de Coagulación
Espacio Extravascular
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Preclampsia/HELLP
10% de Los episodios Severos
Lesión Endotelial Hipertensiva
Altos nivelesTrombina – Antitrombina
α2 Antiplasmina
Agravantes Trombocitopenia
Disfunción Hepática
Hemolisis
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Abrupcio Placentae
Depende Del Grado de AbrupcioCantidad del Sangrado
10 – 15% de ocurrencia
Traspaso de Sustancia Similares a la Tromboplastiba
Activación Uterina del Sistema De CoagulaciónConsumo de Factores
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Retención de feto Muerto
Retención > 5 SemanasIncidencia 25%
Pasos a La circulación SistémicaTromboplastina
Consumo de Factores
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Diagnostico
Alta Sospecha Clínica (Contexto)
Equimosis – Petequias
Sangrado Por Mucosas
Sangrado en Sitio de Ven punción
Sangrado en Heridas
Necrosis hemorrágicaMicro trombos de Fibrina
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Diagnostico
TP
TTP
Fibrinógeno
Dímero D
Niveles de Antitrombi
na
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Score Diagnostico
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Fibrinógeno de la H0 con fibrinógeno> 4g L)1 Tuvo un Valor predictivo negativo del 79% (68–89%), mientras que fibrinógeno < 2 g L) Tuvo un Valor Predictivo Positivo 100% (71–100%) para predecir severidad.
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INTERVENCIONES
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prevención
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Balance Hídrico
Perfusión
Tisular
Evitar Hipoxia
Remover
Etiologia
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HEMODERIVADOS
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ANTIFIBRINOLITICOS
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RESOLVIENDO DUDAS
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NOVOSEVEN®FACTOR VIIa Recombinante
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Factores Que Influnencia La Efectividad Del F. VIIa R
Acidosis
Hipotermia
Trombocitopenia
Hipofibrinogenemia
Hipocalcemia
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Concentrado de Complejo Protrombinico
Algorithm-based coagulation management of catastrophic amniotic fluid embolism. T. Annecke. Blood Coagulation and Fibrinolysis 2010, 21:95–100
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Gracias..!