scholarly journals Coagulation Profile in neonates with perinatal asphyxia

2019 ◽  
Vol 6 (5) ◽  
pp. 1922
Author(s):  
Ruchi Jha ◽  
Neelam Verma
Keyword(s):  
Perinatal Asphyxia ◽  
Mode Of Delivery ◽  
Birth Asphyxia ◽  
Fresh Frozen Plasma ◽  
Control Group ◽  
Severe Bleeding ◽  
Care Seeking ◽  
Second Stage Of Labour ◽  
Care Seeking Behavior ◽  
Fresh Frozen

Background: Perinatal Asphyxia refers to a condition during the first and second stage of labour in which impaired gas exchange leads to fetal acidosis, hypoxemia and hypercarbia. It accounts for about 23 per cent of the four million newborn deaths worldwide.Methods: To estimate the magnitude of coagulation derangement in babies who suffered birth asphyxia and compare it with non-asphyxiated controls.Results: There were 61.9% and 64 % males in both the groups outnumbering females suggesting that the health care seeking behavior for male children is more than for their female counterparts. Birth weight and mode of delivery are comparable in both the groups. PT and APTT were significantly higher in the asphyxiated babies than in their respective control group. It may be noted , however, that PT and APTT values were higher in the control group also, when compared with the reference values. This may indicate that the hemostatic mechanisms are already compromised in the newborns and perinatal asphyxia further augment the situation tilting it in favour of bleeding. Thrombocytopenia is observed in the asphyxiated group which may be due to placental insufficiency. Severe bleeding is significant in asphyxiated group as compared to the control.Conclusion: Dyscoagulation should be considered in all asphyxiated babies, and they may present with clinically significant bleeding, which may require fresh frozen plasma to restore and maintain their coagulation status.

Analysis of Ascites-Challenged Blood in Patients with Liver Cirrhosis Using Rotational Thromboelastometry: How Robust Is the Evidence on Ascites-Attributed Fibrinolysis?

Digestion ◽  
2021 ◽  
pp. 1-6
Author(s):  
Sotiria Bedreli ◽  
Dimitrios Eleftheriadis ◽  
Michael Jahn ◽  
Ali Canbay ◽  
Fuat Saner ◽  
...  
Keyword(s):  
Liver Cirrhosis ◽  
Dilution Effect ◽  
Negative Control Group ◽  
Fresh Frozen Plasma ◽  
Negative Control ◽  
Control Group ◽  
Rotational Thromboelastometry ◽  
Antifibrinolytic Drugs ◽  
Fresh Frozen ◽  
Cirrhotic Patients

Introduction: For over 30 years, ascites has been postulated to facilitate fibrinolysis in patients with liver cirrhosis. In contrast to previous research employing conventional coagulation tests, this study aimed to characterize hemostatic interactions between blood and ascites using the rotational thromboelastometry (ROTEM). Methods: Blood samples – pure or mixed with ascites in a ratio of 1:1 – from cirrhotic patients (n = 10) were subjected to ROTEM analysis. In addition, a negative control group was built with cirrhotic patients (n = 10) whose blood was mixed with physiologic sodium chloride (0.9% NaCl) solution in a ratio of 1:1. Subsequently, ROTEM measurements were subjected to statistical analysis. Results: During ascites challenge, clotting time (CT, measured in seconds) was significantly prolonged in EXTEM (blood: 70.40 ± 20.40 vs. ascites/blood: 109.8 ± 47.7) and APTEM (blood: 66.50 ± 14.55 vs. ascites/blood: 138.7 ± 105.8), likely reflecting a dilution effect. However, CT in INTEM remained unchanged, suggesting a sustained intrinsic pathway function. Maximal clot firmness (measured in millimeters) in FIBTEM decreased significantly (blood: 14.70 ± 9.55 vs. ascites/blood: 6.00 ± 5.66), thus indicating depletion of fibrinogen in ascites. Strikingly, maximum lysis (measured in %) significantly decreased in EXTEM (blood: 9.30 ± 2.79 vs. ascites/blood: 5.50 ± 2.84), APTEM (blood: 8.50 ± 3.10 vs. ascites/blood: 5.60 ± 2.88), and INTEM (blood: 7.50 ± 2.27 vs. ascites/blood: 5.10 ± 3.48). Conclusions: ROTEM provided new evidence that ascites may not primarily induce fibrinolysis in cirrhotic patients. This finding seems to be of significant importance for the clinical management of cirrhotic patients experiencing complications, for example, abdominal hemorrhage after liver biopsy or paracentesis; here, replacement of prothrombin complex concentrates and/or fibrinogen concentrates may prove more beneficial than the use of fresh frozen plasma or antifibrinolytic drugs.

Direct (new) oral anticoagulants (DOACs): Drawbacks, bleeding and reversal

2021 ◽  
Vol 19 ◽  
Author(s):  
Ozgur Karcioglu ◽  
Sehmus Zengin ◽  
Bilgen Ozkaya ◽  
Eylem Ersan ◽  
Sarper Yilmaz ◽  
...  
Keyword(s):  
Oral Anticoagulants ◽  
Fresh Frozen Plasma ◽  
New Oral Anticoagulants ◽  
Coagulation Cascade ◽  
Thrombin Inhibitor ◽  
Severe Bleeding ◽  
Prothrombin Complex Concentrates ◽  
Clinical Scenarios ◽  
Fresh Frozen ◽  
Frozen Plasma

Background and Objective: Direct (new) Oral Anticoagulants (DOACs) have emerged as a contemporary and promising option in the treatment of thromboses and VTE, while protecting the coagulation cascade against untoward bleeding events. They are used in the management and prophylaxis of Venous Thromboembolism (VTE) and other thrombotic diseases. The most prominent complication of these agents is bleeding. These agents have similar or lower rates of major intracranial hemorrhages, while they had a higher risk of major gastrointestinal bleeding when compared to warfarin. This manuscript is aimed to revise and update the literature findings to outline the side effects of DOACs in various clinical scenarios. Methods: A narrative review of currently published studies was performed. Online database searches were performed for clinical trials published before July 2021, on the efficacy and adverse effects attributed to the anticoagulant treatment, especially DOACs. A literature search via electronic databases was carried out, beginning with the usage of the agents in the Western Languages papers. The search terms initially included direct (new) oral anticoagulants, dabigatran, rivaroxaban, apixaban, edoxaban, idarucizumab, andexanet, prothrombin complex concentrates, and fresh frozen plasma. Papers were examined for methodological soundness before being included. Results: Severe bleeding episodes require aggressive interventions for successful management. Therefore, bleeding should be evaluated in special regard to the location and rate of hemorrhage, and total volume of blood loss. Patient's age, weight and organ dysfunctions (e.g., kidney/liver failure or chronic respiratory diseases) directly affect the clinical course of overdose. Conclusion: Management recommendations for hemorrhage associated with DOAC use vary, depending on the class of the culprit agent (direct thrombin inhibitor vs. FXa inhibitor), the clinical status of the patient (mild/ moderate vs. severe/life-threatening), and capabilities of the institution. Specific reversal agents (i.e., idarucizumab and andexanet alfa) can be used if available, while prothrombin complex concentrates, fresh frozen plasma and/ or tranexamic acid can also be employed as nonspecific replacement agents in the management of DOAC-related bleeding diathesis.

MATERNOFETAL OUTCOME IN MECONIUM STAINED LIQUOR AT TERTIARY CARE HOSPITAL

2021 ◽  
pp. 48-50
Author(s):  
Neha Agarwal ◽  
Samta Bali Rathore ◽  
Shivani Baberwal-
Keyword(s):  
Caesarean Section ◽  
Perinatal Asphyxia ◽  
Tertiary Care ◽  
Mode Of Delivery ◽  
Birth Asphyxia ◽  
Meconium Aspiration Syndrome ◽  
Care Hospital ◽  
Pregnancy Induced Hypertension ◽  
Meconium Aspiration ◽  
Induced Hypertension

BACKGROUND: Occurance of meconium-stained amniotic uid (MSAF) during labour may be considered as a measure for prediction of poor fetal outcomes such as meconium aspiration syndrome and perinatal asphyxia ,resulting in perinatal as well as neonatal morbidity and mortality. It constitutes about 5% of deliveries with meconium stained amniotic uid and death results in about 12% of infants with MAS. METHODS: 40 cases of meconium stained liquor detected after spontaneous or artical rupture of membranes taken during labour from june 2020 to december 2020 and their outcome in terms of mode of delivery(whether vaginal delivery or lower segment caesarean section) and fetal outcome and associated maternal high risk were studied RESULT: Anemia was co existant in around 15%, pregnancy induced hypertension(PIH) in 25%and premature rupture of membrane in 10%.Pregnancies complicated with Pregnancy induced hypertension had signicant higher rate of meconium stained liquor among all cases. Caesarean Section was commonly performed in meconium stained amniotic uid cases and accounted for about 65%of all cases. CONCLUSIONS: Meconium Stained amniotic uid increases the chances of caesarean rates,leading to birth asphyxia ,Meconium Aspiration Syndrome and hence increases the chances of neonatal intensive unit admission.

scholarly journals Clinical Profile of Neonates with Perinatal Asphyxia in a Tertiary Care Hospital of Central Nepal

2014 ◽  
Vol 52 (196) ◽  
pp. 1005-1009
Author(s):  
Sweta Kumari Gupta ◽  
Bhawani Kanta Sarmah ◽  
Damodar Tiwari ◽  
Amshu Shakya ◽  
Dipendra Khatiwada
Keyword(s):  
Perinatal Asphyxia ◽  
Tertiary Care ◽  
Mode Of Delivery ◽  
Birth Asphyxia ◽  
Clinical Information ◽  
Clinical Problem ◽  
Presentation Mode ◽  
Care Hospital ◽  
Central Nepal ◽  
Bag And Mask Ventilation

Introduction: Birth asphyxia is a serious clinical problem worldwide. It claims approximately 9 million deaths each year. It can lead to serious neurological sequaele, such as cerebral palsy, mental retardation, and epilepsy. Methods: All babies admitted in College of Medical Sciences Teaching Hospital, Chiwan, Nepal, NICU from January 2013 to December 2013 with a diagnosis of birth asphyxia (5 min Apgar<7 or those with no spontaneous respirations after birth) were included in the study (n=125). This was a descriptive observational study. Clinical information was collected (gravida, hour at presentation, mode of delivery, sex of baby, gestational age of the baby, requirement of resuscitation). Neonates were admitted to NICU, observed for complications and managed as per hospital protocol. Results: Among the 722 neonates admitted to NICU, 125 had perinatal asphyxia (17.3%). Babies with Hypoxic ischemic encephalopathy(HIE) Grade I had a very good outcome but HIE III was associated with a poor outcome. Outborn neonates had higher grades of perinatal asphyxia as compared to inborns (p=0.018). Term gestation, Males and Multigravida were associated with a higher rate of birth asphyxia. 22.4% neonates were delivered via caesarean section and 74.4% required bag and mask ventilation at birth. Conclusions: Birth asphyxia was one of the commonest causes of admission NICU. Babies with HIE Grade III had a very poor prognosis. Outborn neonates with birth asphyxia had a higher mortality. Males were frequently affected than females.  Keywords: birth asphyxia; HIE; mortality; measurement.

scholarly journals Perinatal outcome in meconium-stained amniotic fluid at term: a single center prospective study

2020 ◽  
Vol 10 (1) ◽  
pp. 107
Author(s):  
Vandana Mohapatra ◽  
Sujata Misra ◽  
Tapas Ranjan Behera
Keyword(s):  
Caesarean Section ◽  
Amniotic Fluid ◽  
Pregnant Women ◽  
Perinatal Outcome ◽  
Mode Of Delivery ◽  
Birth Asphyxia ◽  
Control Group ◽  
Study Group ◽  
The Mean ◽  
Meconium Stained Amniotic Fluid

Background: The presence of meconium-stained amniotic fluid is a sign of fetal compromise and is associated with increased perinatal morbidity. The objective of this study was to determine the perinatal outcome in pregnant women at term with meconium-stained amniotic fluid (MSAF) and compare it with the outcome associated with clear liquor. Methods: A prospective observational, study was conducted in the department of obstetrics and gynecology, VIMSAR, Burla from January, 2013 to June, 2013. Pregnant women with singleton pregnancy, cephalic presentation at term were included in the study. Total 135 cases of MSAF (study group) were compared with 165 randomly selected controls with clear liquor. Outcome measures were fetal heart rate (FHR) abnormality, mode of delivery, Apgar score, neonatal intensive care unit (NICU) admission, diagnosis of meconium aspiration syndrome (MAS), birth asphyxia and neonatal death. Statistical analysis was done by using the mean and Chi-square test with or without Yates’ correction.  Results: The mean gestational age for meconium staining in the present study was 40.31±0.48 weeks. Caesarean section was the most common mode of delivery in MSAF group whereas vaginal delivery was most common in control group. Significantly higher number of babies in the study group required NICU admissions. The incidence of MAS and birth asphyxia too was statistically higher among babies born to study group as compared to control group.Conclusions: MSAF has significant adverse effect on the perinatal outcome, as it increases the caesarean section rates, NICU admissions, MAS and birth asphyxia.

TO STUDY THE CORRELATION OF URINARY URIC ACID AND CREATININE RATIO IN BIRTH ASPHYXIA

2021 ◽  
pp. 53-54
Author(s):  
B Revanth Reddy ◽  
Gauri Chauhan ◽  
Anand Kumar Bhardwaj ◽  
Sasanka Chakrabarti
Keyword(s):  
Uric Acid ◽  
Apgar Score ◽  
Perinatal Asphyxia ◽  
Birth Asphyxia ◽  
Control Group ◽  
P Value ◽  
Creatinine Ratio ◽  
Spot Urine ◽  
Spot Urine Sample ◽  
And Control

Introduction: Perinatal asphyxia is one of the leading causes of perinatal morbidity and mortality. Feasible and early biochemical markers to diagnose and predict the neurologic outcome is a great need of time as APGAR score alone is inuenced by various factors. The present study was performed to determine the urinary uric acid to creatinine ratio in perinatal asphyxia and its correlation with APGAR score and compare urinary uric acid to creatinine ratio with Sarnat and Sarnat staging. Materials and Methods: This study was carried out on 100 term neonates with an equal number of cases and control 50 each, control group being the neonates with Apgar score ≥ 7 at 1 minute of life and cases being the neonates who suffered from perinatal asphyxia with Apgar < 7 at 1 minute of life. The spot urine sample was collected within 24 hours of birth and their uric acid and creatinine levels were measured and the ratio calculated. Asphyxiated neonates were classied according to Sarnat and Sarnat staging. We Compare UA/Cr ratio with Apgar score and HIE staging using Sarnat and Sarnat staging.Results: On comparison of UUA/Cr among cases and controls we found that ratio was signicantly higher in asphyxiated neonates as compared to non asphyxiate neonates. (Control vs. Cases Group: 2.4 ± 1 vs. 3.6 ± 1.5; p –value < 0.0001). On comparison of UUA/Cr among cases with Sarnat and Sarnat staging of HIE, there is a signicant difference observed in mean UA/Cr ratio across Sarnat and Sarnat staging of HIE (F – Value = 68.760; p – value = 0.0001). Conclusion: Urinary uric acid and creatinine ratio can be used as markers for perinatal asphyxia for screening in centers where other markers for assessing perinatal asphyxia are not available. Urinary uric acid and creatinine ratio is a non-invasive, cheap and easily available marker for assessing the severity perinatal asphyxia.

scholarly journals Study of cord blood nucleated RBC’s as a marker for fetal asphyxia

2017 ◽  
Vol 6 (2) ◽  
pp. 658
Author(s):  
Suvarna Jyothi Ganta ◽  
Sunanda R. Kulkarni
Keyword(s):  
Cord Blood ◽  
Perinatal Asphyxia ◽  
Birth Asphyxia ◽  
Control Group ◽  
Apgar Scores ◽  
Hypoxic Episode ◽  
The Mean ◽  
Ischemic Encephalopathy ◽  
Control Study

Background: Perinatal asphyxia is a serious problem globally and is a common cause of neonatal mortality and long term morbidity. Various Parameters are being used as predictors for birth asphyxia but the correlation between clinical presentation and the biochemical results has been unsatisfactory. NRBC count of the cord blood is reported in literature as a possible marker of perinatal asphyxia. In-utero hypoxic episode may induce a haemopoetic response of exaggerated erythropoiesis leading to the presence of nucleated RBC's in fetal circulation. The aim of this study was to investigate whether NRBC count of the cord blood can be a useful parameter to determine perinatal asphyxia.Methods: This prospective case control study was conducted in Chinmaya Mission hospital, Bangalore, India between July 2015 to June 2016.we have studied the NRBC counts from the cord blood of 50 neonates with perinatal asphyxia and 50 healthy neonates, thus comparing the results.Results: The mean NRBC /100 WBC for cases with birth asphyxia was 11.6 and that of the control group was 5.6. NRBC count was found to be significantly higher in neonates with low Apgar scores. There was correlation between the Apgar scores at 1st and at 5 minutes, the degree of Hypoxic Ischemic Encephalopathy and the NRBC counts.Conclusions: Therefore NRBC counts of the cord blood can be used as an effective tool to confirm perinatal asphyxia. It is a simple, quick, accurate and clinically effective test to diagnose and initiate treatment to prevent long term sequel of perinatal asphyxia.

IVH in VLBW Preterm Babies – Therapy with Recombinant Activated F VII?

2017 ◽  
Vol 229 (06) ◽  
pp. 335-341 ◽  
Author(s):  
Matthias Knüpfer ◽  
Jenny Ritter ◽  
Ferdinand Pulzer ◽  
Corinna Gebauer ◽  
Nadine Wolf ◽  
...  
Keyword(s):  
Very Low Birth Weight ◽  
Demographic Data ◽  
Fresh Frozen Plasma ◽  
Coagulation Cascade ◽  
Factor Vii ◽  
Control Group ◽  
Posthemorrhagic Hydrocephalus ◽  
Activated Factor Vii ◽  
Fresh Frozen ◽  
Group A

Abstract Backround Intraventricular hemorrhage (IVH) remains a dangerous and frequent complication in very low birth weight (VLBW) infants. Activated factor VII (aFVII) activates the coagulation cascade and is a potential tool for stopping active bleeding, including limiting the extent of an IVH. This retrospective treatment observation compared data for infants with IVH progression treated with fresh frozen plasma (FFP) alone or with a combination of FFP and aFVII. Methods/Intervention All infants were subject to cranial ultrasonography at least twice daily. When an IVH was detected, treatment with FFP (5–20 ml/kg every 4–6 h) was commenced and the parents were informed. If the parents endorsed aFVII treatment and the IVH showed progress, aFVII (30–50 µg/kg body weight 4–6 times within 16–24 h) was given. Otherwise, infants were treated with FFP only. We compared the course of IVH between the aFVII+FFP treated infants and a control group (FFP only). Results 35 patients throughout were included in the analysis (17 control and 18 aFVII group). Demographic data was not different between groups. The progress of IVH was significantly less in the aFVII group (p<0.01). During the hospital stay, 2 of the infants in the aFVII group died compared to 4 in the control group. A posthemorrhagic hydrocephalus developed in 3 aFVII and 6 control infants. All other outcome parameters and follow-up-results 2 years after treatment did not differ significantly. Conclusion These data show that in the case of a progressing IVH, aFVII may be a candidate for limiting its extent. A prospective randomized trial is warranted.

scholarly journals Variations and obstacles in the use of coagulation factor concentrates for major trauma bleeding across Europe: outcomes from a European expert meeting

2021 ◽  
Author(s):  
Vladimir Černý ◽  
Marc Maegele ◽  
Vanessa Agostini ◽  
Dietmar Fries ◽  
Santiago R. Leal-Noval ◽  
...  
Keyword(s):  
Coagulation Factor ◽  
Fresh Frozen Plasma ◽  
Severe Bleeding ◽  
Fibrinogen Concentrate ◽  
European Guidelines ◽  
First Line Therapy ◽  
Fresh Frozen ◽  
Coagulation Factor Concentrates ◽  
Barriers To Use ◽  
Definition Of

Abstract Purpose Trauma is a leading cause of mortality, with major bleeding and trauma-induced coagulopathy (TIC) contributing to negative patient outcomes. Treatments for TIC include tranexamic acid (TXA), fresh frozen plasma (FFP), and coagulation factor concentrates (CFCs, e.g. prothrombin complex concentrates [PCCs] and fibrinogen concentrate [FCH]). Guidelines for TIC management vary across Europe and a clear definition of TIC is still lacking. Methods An advisory board involving European trauma experts was held on 02 February 2019, to discuss clinical experience in the management of trauma-related bleeding and recommendations from European guidelines, focusing on CFC use (mainly FCH). This review summarises the discussions, including TIC definitions, gaps in the guidelines that affect their implementation, and barriers to use of CFCs, with suggested solutions. Results A definition of TIC, which incorporates clinical (e.g. severe bleeding) and laboratory parameters (e.g. low fibrinogen) is suggested. TIC should be treated immediately with TXA and FCH/red blood cells; subsequently, if fibrinogen ≤ 1.5 g/L (or equivalent by viscoelastic testing), treatment with FCH, then PCC (if bleeding continues) is suggested. Fibrinogen concentrate, and not FFP, should be administered as first-line therapy for TIC. Several initiatives may improve TIC management, with improved medical education of major importance; generation of new and stronger data, simplified clinical practice guidance, and improved access to viscoelastic testing are also critical factors. Conclusions Management of TIC is challenging. A standard definition of TIC, together with initiatives to facilitate effective CFC administration, may contribute to improved patient care and outcomes.

The Risk of Thrombotic Events in Neonates Treated with Recombinant Factor VIIa.

Blood ◽  
2007 ◽  
Vol 110 (11) ◽  
pp. 3193-3193
Author(s):  
John Puetz ◽  
Ginger Darling ◽  
Petr Brabec ◽  
Jan Blatny ◽  
Prasad Mathew
Keyword(s):  
Recombinant Factor Viia ◽  
Factor Viia ◽  
Accurate Determination ◽  
Thrombotic Event ◽  
Fresh Frozen Plasma ◽  
Factor Vii ◽  
Control Group ◽  
Fresh Frozen ◽  
Surgical Bleeding ◽  
A Prospective Study

Abstract Background: In recent years, recombinant factor VIIa (rFVIIa) has been used in non-hemophilia bleeding situations (factor VII deficiency, trauma, liver disease, uremia, surgical bleeding, platelet disorders, and intracranial hemorrhage) for achievement of hemostasis. Although, the risk of thrombosis in hemophilia patients with inhibitors receiving rFVIIa is quite low, its use in other clinical situations has been complicated by some reports of thrombotic events. Recently, rFVIIa has been used to treat coagulopathic and/or bleeding neonates with good success. However, the prevalence of thrombotic events in these neonates is completely unknown. This study was initiated to determine the risk of thrombotic events associated with rFVIIa use in neonates. Methods: We reviewed all published literature in neonates receiving rFVIIa. In addition, we reviewed all data submitted to the SeveN Bleep Registry, a database developed by the scientific standardization subcommittee on pediatric and neonatal hemostasis of the International Society on Thrombosis and Haemostasis (ISTH) to record all uses of rFVIIa in pediatric non-hemophilic patients. As the baseline prevalence of thrombosis for bleeding and/or coagulopathic neonates is also unknown, we also reviewed the records of 100 consecutive neonates from a single institution who received fresh frozen plasma (FFP) alone to treat their coagulopathy and/or bleeding. Results: A total of 98 non-hemophilic neonates received rFVIIa. The majority of these neonates received rFVIIa only after failing to achieve hemostasis with standard care (FFP, cryoprecipitate, platelet transfusions). Of those receiving rFVIIa, 7 had a thrombotic event reported. In the control group that received FFP alone, 7 neonates also suffered a thrombotic event. Although the risk of thrombosis in these two groups is similar, neonates receiving rFVIIa tended to have indwelling line related thrombosis, while those receiving FFP tended to have strokes or myocardial insults. Overall the prevalence of thrombotic events in bleeding and/or coagulopathic neonates appears to be 7%, whether or not they received rFVIIa. Conclusions: In this study, the overall prevalence of thrombotic events was similar in the rFVIIa and FFP group. As data for this study was collected in a retrospective manor, and thereby subject to publication and submission bias, a more accurate determination of the prevalence of thrombosis in neonates will require a prospective study.

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