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Mauny L, Peyronnet V, Peynaud-Debayle E, Picone O, Nebout S, Mandelbrot L. Induction or spontaneous labor for pregnant patients on anticoagulants? J Gynecol Obstet Hum Reprod 2023; 52:102623. [PMID: 37308038 DOI: 10.1016/j.jogoh.2023.102623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 06/08/2023] [Accepted: 06/09/2023] [Indexed: 06/14/2023]
Abstract
OBJECTIVE There are two approaches to peripartum management for pregnant patients undergoing anticoagulation treatments: spontaneous labor or scheduling an induction. A long interval without anticoagulation is a thrombosis risk factor, while a short interval leads to risks of delivery without epidural analgesia or post partum hemorrhage. Our objective was to evaluate the impact of planned induction versus spontaneous labor on obtaining neuraxial analgesia. MATERIALS AND METHODS A retrospective single-center study was conducted from 2012 to 2020 including all patients on preventive or curative low molecular-weight heparin at the time of delivery, excluding planned cesarean sections. The rates of neuraxial analgesia were compared between two groups: spontaneous labor and induction, as well as the intervals without anticoagulants. RESULTS 127 patients were included. In the spontaneous labor group, 78% (44/56) received neuraxial analgesia versus 88% (37/42) in the induction group (p = 0.29). For curative dose treatment, the rate of neuraxial analgesia was 45,5% in the spontaneous group versus 78,6% (p = 0.12). The median time without anticoagulation was 34 h [26-46] in the spontaneous labor group and 43 h [34-54] in the induction group (p = 0.01), without an increased incidence of thrombosis. The rate of postpartum hemorrhage did not differ between the two groups. CONCLUSION Planned induction tended to increase the rate of neuraxial analgesia, without reaching significance, and most women in spontaneous labor accessed analgesia. Peripartum management should be a shared decision with the patient considering the obstetrical and thrombosis risk context for each patient.
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Affiliation(s)
- Lea Mauny
- Assistance Publique des Hôpitaux de Paris Department of Obstetrics and Gynecology, Hôpital Louis Mourier, Colombes, France; Université Paris Cité, Paris, France
| | - Violaine Peyronnet
- Assistance Publique des Hôpitaux de Paris Department of Obstetrics and Gynecology, Hôpital Louis Mourier, Colombes, France; Fédération Hospital-universitaire PREMA, Paris, France.
| | - Edith Peynaud-Debayle
- Assistance Publique des Hôpitaux de Paris Department of Hematology, Hôpital Louis Mourier, Colombes, France
| | - Olivier Picone
- Assistance Publique des Hôpitaux de Paris Department of Obstetrics and Gynecology, Hôpital Louis Mourier, Colombes, France; Université Paris Cité, Paris, France; Fédération Hospital-universitaire PREMA, Paris, France; Inserm IAME, Paris, France
| | - Sophie Nebout
- Assistance Publique des Hôpitaux de Paris Department of Anethesiology, Hôpital Louis Mourier, Colombes, France
| | - Laurent Mandelbrot
- Assistance Publique des Hôpitaux de Paris Department of Obstetrics and Gynecology, Hôpital Louis Mourier, Colombes, France; Université Paris Cité, Paris, France; Fédération Hospital-universitaire PREMA, Paris, France; Inserm IAME, Paris, France
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Grabarz A, Ghesquière L, Debarge V, Ramdane N, Delporte V, Bodart S, Deruelle P, Subtil D, Garabedian C. Cesarean section complications according to degree of emergency during labour. Eur J Obstet Gynecol Reprod Biol 2020; 256:320-325. [PMID: 33264691 DOI: 10.1016/j.ejogrb.2020.11.047] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Revised: 11/11/2020] [Accepted: 11/14/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Evaluate the complications rate of cesarean section delivery based on degree of labour emergency. STUDY DESIGN Monocentric (Lille, France), retrospective study of all term, singleton, and cesarean deliveries during labour. Three groups were categorized based on the degree of emergency according to a color code: green (no time limit between surgical decision and birth), orange (birth within 30 min), and red (birth within 20 min). Scheduled cesareans were excluded. Complications were defined as minor/major and intra-/post-operative. RESULTS A total of 881 patients were included. Among these, 303 (34.5 %) were in the green group, 353 (40.1 %) in the orange group, and 225 (25.4 %) in the red group. Major intra-operative complications, mainly postpartum hemorrhage, were more frequent in the red group compared with the green group (16.9 % vs. 9.9 %, p = 0.05; OR 1.9; 95 % CI [1.1-3.1]). Among the minor complications, there was no difference on moderate postpartum hemorrhage and four times uterine artery wounds in the red group (1.7 % vs. 7.1 %, respectively; p = 0.007; OR 4.6; 95 % CI [1.6-12.6]). The overall major post-operative complication rate, mainly infectious morbidity, was 6.1 % and this was more frequent in the red group compared with the green group (12.4 % vs. 1.7 %, respectively; p < 0.0001; OR 8.5; 95 % CI [3.2-22.3]). CONCLUSION Pre- and post-operative complications of cesarean section delivery during labour (i.e., emergency cesarean) increase with the degree of labour emergency. It would be ideal to identify women in labour who are at increased risk of emergency cesarean earlier, so that the situation does not escalate to a red code cesarean.
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Affiliation(s)
- A Grabarz
- CHU Lille, Department of Obstetrics, F-59000 Lille, France
| | - L Ghesquière
- CHU Lille, Department of Obstetrics, F-59000 Lille, France; Univ. Lille, CHU Lille, ULR 2694 - METRICS: Évaluation des technologies de santé et des pratiques médicales, F-59000 Lille, France.
| | - V Debarge
- CHU Lille, Department of Obstetrics, F-59000 Lille, France; Univ. Lille, CHU Lille, ULR 2694 - METRICS: Évaluation des technologies de santé et des pratiques médicales, F-59000 Lille, France
| | - N Ramdane
- CHU Lille, Studies and Research in Medical Informatics Center, F-59045 Lille cedex, France
| | - V Delporte
- CHU Lille, Department of Obstetrics, F-59000 Lille, France
| | - S Bodart
- CHU Lille, Department of Obstetrics, F-59000 Lille, France
| | - P Deruelle
- CHU Lille, Department of Obstetrics, F-59000 Lille, France
| | - D Subtil
- CHU Lille, Department of Obstetrics, F-59000 Lille, France; Univ. Lille, CHU Lille, ULR 2694 - METRICS: Évaluation des technologies de santé et des pratiques médicales, F-59000 Lille, France
| | - C Garabedian
- CHU Lille, Department of Obstetrics, F-59000 Lille, France; Univ. Lille, CHU Lille, ULR 2694 - METRICS: Évaluation des technologies de santé et des pratiques médicales, F-59000 Lille, France
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Huang D, Zhu L, Chen J, Zhou J. Minimally invasive spinal anesthesia for cesarean section in maternal anticoagulation therapy: a randomized controlled trial. BMC Anesthesiol 2019; 19:11. [PMID: 30636632 PMCID: PMC6330402 DOI: 10.1186/s12871-018-0679-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2018] [Accepted: 12/28/2018] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Anticoagulant therapy during pregnancy is widely used due to the increasing awareness of maternal hypercoagulability. Few studies have reported the use of minimally invasive spinal anesthesia in these parturients. The objective of this study was to evaluate the safety and feasibility of minimally invasive spinal anesthesia in parturients with anticoagulation therapy undergoing cesarean section. METHODS This was a randomized, controlled study conducted in 239 parturients using anticoagulants and undergoing selective cesarean section. 37 parturients withdrew, and finally parturients received spinal anesthesia using 27gauge pen type fine spinal needles (experimental group, n = 110) and 22gauge traditional spinal needles (control group, n = 92). The primary efficacy outcomes included low back pain (LBP) and postdural puncture headache (PDPH) after delivery. Secondary efficacy outcomes included visual analogue scale during subarachnoid puncture (VASdural), difference between visual analogue scale (VAS) during peripheral venipuncture and VASdural (∆VAS), VAS of back puncture point 24, 48 and 72 h after operation (VASdural-24 h, VASdural-48 h and VASdural-72 h, respectively), maternal satisfaction and hospitalization stay. RESULTS No parturient had PDPH and was suspected with spinal or intracranial haematoma in two groups. There was no significant difference in VASlbp-24 h, VASlbp-48 h and VASlbp-72 h (P = 0.056; P = 0.813; P = 0.189, respectively) between two groups. In experimental group, VASdural (P = 0.017), ∆VAS (P = 0.001) and VASdural-24 h (P < 0.0001) were lower, whereas maternal satisfaction was higher (P = 0.046). There was no significant difference in VASdural-48 h, VASdural-72 h, urination function, strength recovery and hospitalization stay (P = 0.069; P = 0.667; P = 0.105; P = 0.133; P = 0.754, respectively) between the two groups. CONCLUSIONS Minimally invasive spinal anesthesia provided lower VASdural, VASdrual-24 h and a higher maternal satisfaction. Hence, it is considered as a safe, reliable and reasonable option for cesarean section parturients during maternal anticoagulation therapy with normal platelet count and coagulation time. TRIAL REGISTRATION This study was registered at www.ClinicalTrials.gov at November 11th, 2016 ( NCT02987192 ).
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Affiliation(s)
- Dan Huang
- Department of Anesthesiology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, 200127 China
| | - Linjie Zhu
- Department of Anesthesiology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, 200127 China
| | - Jie Chen
- Department of Anesthesiology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, 200127 China
| | - Jie Zhou
- Department of Anesthesiology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, 200127 China
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Is a therapeutic anticoagulation window needed for delivery when using prophylactic low molecular weight heparin during pregnancy? A retrospective monocentric study. Eur J Obstet Gynecol Reprod Biol 2017; 215:118-123. [DOI: 10.1016/j.ejogrb.2017.05.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Revised: 05/05/2017] [Accepted: 05/23/2017] [Indexed: 12/20/2022]
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Ficheur G, Caron A, Beuscart JB, Ferret L, Jung YJ, Garabedian C, Beuscart R, Chazard E. Case-crossover study to examine the change in postpartum risk of pulmonary embolism over time. BMC Pregnancy Childbirth 2017; 17:119. [PMID: 28410584 PMCID: PMC5391590 DOI: 10.1186/s12884-017-1283-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Accepted: 03/21/2017] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Although the current guidelines recommend anticoagulation up until 6 weeks after delivery in women at high risk of venous thromboembolism (VTE), the risk of VTE may extend beyond 6 weeks. Our objective was to estimate the risk of a pulmonary embolism in successive 2-week intervals during the postpartum period. METHODS In a population-based, case-crossover study, we analyzed the French national inpatient database from 2007 to 2013 (n = 5,517,680 singleton deliveries). Using ICD-10 codes, we identified women who were diagnosed with a postpartum pulmonary embolism between July 1st, 2008, and December 31st, 2013. Deliveries were identified during a case "period" immediately before the pulmonary embolism, and five different control periods one year before the pulmonary embolism. Using conditional logistic regression, Odds ratios (ORs) and 95% confidential intervals (CIs) were estimated for ten successive 2-week intervals that preceded the diagnosis of pulmonary embolism. RESULTS We identified 167,103 cases with a pulmonary embolism during the inclusion period. After delivery, the risk of pulmonary embolism declined progressively over time, with an OR [95%CI] of 17.2 [14.0-21.3] in postpartum weeks 1 to 2 and 1.9 [1.4-2.7] in postpartum weeks 11 to 12. The OR [95%CI] in postpartum weeks 13 to 14 was 1.4 [0.9-2.0], and the OR did not fall significantly after postpartum week 14. CONCLUSIONS Our findings indicate that women are at risk of a pulmonary embolism up to 12 weeks after delivery. The shape of the risk curve suggests that the risk decreases exponentially over time. Future research is needed to establish whether the duration of postpartum anticoagulation should be extended beyond 6 weeks.
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Affiliation(s)
- Grégoire Ficheur
- Department of public health, Lille University Hospital, EA 2694 - Public health: Epidemiology and quality of care, 2 Avenue Oscar Lambret, F-59000, Lille, France.
| | - Alexandre Caron
- Department of public health, Lille University Hospital, EA 2694 - Public health: Epidemiology and quality of care, 2 Avenue Oscar Lambret, F-59000, Lille, France
| | - Jean-Baptiste Beuscart
- Department of public health, Lille University Hospital, EA 2694 - Public health: Epidemiology and quality of care, 2 Avenue Oscar Lambret, F-59000, Lille, France
| | - Laurie Ferret
- Department of pharmacology and clinical pharmacy, Lille University Hospital, 2 Avenue Oscar Lambret, F-59000, Lille, France
| | - Yu-Jin Jung
- Department of public health, Lille University Hospital, EA 2694 - Public health: Epidemiology and quality of care, 2 Avenue Oscar Lambret, F-59000, Lille, France
| | - Charles Garabedian
- Department of Obstetrics, Lille University Hospital, Jeanne de Flandre Hospital, 2 Avenue Oscar Lambret, F-59000, Lille, France
| | - Régis Beuscart
- Department of public health, Lille University Hospital, EA 2694 - Public health: Epidemiology and quality of care, 2 Avenue Oscar Lambret, F-59000, Lille, France
| | - Emmanuel Chazard
- Department of public health, Lille University Hospital, EA 2694 - Public health: Epidemiology and quality of care, 2 Avenue Oscar Lambret, F-59000, Lille, France
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Renner J, Mercier FJ. [Study of the 21 cases of thromboembolism from the 4th report of national confidential enquiry into maternal death in France in 2007-2009]. J Gynecol Obstet Hum Reprod 2016; 45:608-618. [PMID: 26321616 DOI: 10.1016/j.jgyn.2015.06.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Revised: 06/18/2015] [Accepted: 06/29/2015] [Indexed: 06/04/2023]
Abstract
OBJECTIVES The Confidential National Enquiry on Maternal Mortality identified 254 deaths in France from 2007 to 2009. Thromboembolism venous disease led to 31 deaths, becoming the 3rd cause of maternal mortality. This study analyses the 21 enquiry files obtained by the National Expert Committee on Maternal Mortality (CNEMM). MATERIALS AND METHODS Clinical characteristics, arising circumstances and imaging exams were collected in the 20 patients deceased by pulmonary embolism (PE). After excluding two incomplete files, we looked for the PE Risk Factors (RF) in order to sort patients out according to 4 levels of risk (low, moderate, high and major). RESULTS The main RF were: non-Caucasian ethnic origin (n=8), age over 35years (n=7), diabetes (n=6) and emergency or unplanned caesarean section (n=6). The average number of RF was 3.7: 73% were low, 18% moderate. Among 7 autopsies performed, 6 resulted in PE diagnostic. Only 67% of eligible patients had an imaging exam. CONCLUSION The search for the RF of thromboembolism accidents, in particular the low RF, should be improved to establish an adapted prophylactic therapy. Autopsy or even post-mortem imaging should be implemented when diagnosis is uncertain in order to avoid over-/under-estimating death incidence caused by PE.
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Affiliation(s)
- J Renner
- Département d'anesthésie-réanimation, université Paris-Sud (Paris XI), hôpital Antoine-Béclère, groupe hospitalier universitaire Paris-Sud, AP-HP, 157, rue de la porte de Trivaux, 92141 Clamart, France.
| | - F J Mercier
- Département d'anesthésie-réanimation, université Paris-Sud (Paris XI), hôpital Antoine-Béclère, groupe hospitalier universitaire Paris-Sud, AP-HP, 157, rue de la porte de Trivaux, 92141 Clamart, France.
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Postoperative pelvic pain: An imaging approach. Diagn Interv Imaging 2015; 96:1065-75. [DOI: 10.1016/j.diii.2015.07.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Accepted: 07/24/2015] [Indexed: 01/21/2023]
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Influence d’un traitement anticoagulant pendant la grossesse sur l’anesthésie per-partum et les modalités d’accouchement. ACTA ACUST UNITED AC 2015; 43:502-8. [DOI: 10.1016/j.gyobfe.2015.06.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2015] [Indexed: 02/05/2023]
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Lavigne-Lissalde G, Aya AG, Mercier FJ, Roger-Christoph S, Chauleur C, Morau E, Ducloy-Bouthors AS, Mignon A, Raucoules M, Bongain A, Boehlen F, de Moerloose P, Bouvet S, Fabbro-Peray P, Gris JC. Recombinant human FVIIa for reducing the need for invasive second-line therapies in severe refractory postpartum hemorrhage: a multicenter, randomized, open controlled trial. J Thromb Haemost 2015; 13:520-9. [PMID: 25594352 DOI: 10.1111/jth.12844] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2014] [Accepted: 12/31/2014] [Indexed: 01/06/2023]
Abstract
BACKGROUND Case reports on recombinant human factor VIIa (rhuFVIIa) use in women with severe postpartum hemorrhage (PPH) showed encouraging results, but no randomized controlled trial (RCT) is available. PATIENTS AND METHODS Eighty-four women with severe PPH unresponsive to uterotonics were randomized to receive one early single rhuFVIIa infusion (n = 42) or standard care (no rhuFVIIa; n = 42). The primary efficacy outcome measure was the reduction of the need for specific second-line therapies, such as interventional hemostatic procedures, for blood loss and transfusions. The primary safety outcome measure was the number of deaths and thrombotic events during the 5 days following rhuFVIIa infusion. RESULTS rhuFVIIa was associated with a reduction in the number of patients who needed second-line therapies compared with controls (standard care). Specifically, 39/42 (93%) patients in the standard care arm received second-line therapies and 22/42 (52%) patients in the rhuFVIIa arm (absolute difference, 41%; range, 18-63%; relative risk RR, 0.56 [0.42-0.76]). The delivery mode (vaginal or Cesarean section) did not affect the primary outcome. No death occurred. Two venous thrombotic events were recorded in the rhuFVIIa arm: one ovarian vein thrombosis and one deep vein thrombosis with a non-severe pulmonary embolism. CONCLUSION This open RCT in women with severe PPH refractory to uterotonics shows that rhuFVIIa reduces the need for specific second-line therapies in about one in three patients, with the occurrence of non-fatal venous thrombotic events in one in 20 patients.
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Affiliation(s)
- G Lavigne-Lissalde
- Laboratory of Hematology, Carémeau University Hospital, Nîmes, France; Research group EA2992, Montpellier University, Nîmes, France
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Horellou MH, Plu-Bureau G, Lepercq J. [Venous thromboembolism and pregnancy]. Rev Med Interne 2014; 36:219-24. [PMID: 25475826 DOI: 10.1016/j.revmed.2014.10.356] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2014] [Accepted: 10/20/2014] [Indexed: 12/15/2022]
Abstract
Venous thromboembolism (VTE) is a major cause of maternal morbidity and mortality during or early after pregnancy. Prior VTE or family history of VTE, clinical or biological risk factors increased the risk of pregnancy-related VTE. Defining the risk of VTE before or at the beginning of pregnancy is necessary to propose the best prevention. However, the management is not standardized between physicians, centres and countries. Current guidelines for prophylaxis and treatment of VTE are discussed in this review.
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Affiliation(s)
- M-H Horellou
- Service d'hématologie biologique, hôpitaux universitaires Paris Centre-Cochin, 27, rue du Faubourg-Saint-Jacques, 75679 Paris cedex14, France; Faculté de médecine Paris-Descartes, France.
| | - G Plu-Bureau
- Faculté de médecine Paris-Descartes, France; Service de gynécologie médicale, hôpitaux universitaires Paris Centre-Cochin, Paris, France
| | - J Lepercq
- Faculté de médecine Paris-Descartes, France; Service d'obstétrique, hôpitaux universitaires Paris Centre-Cochin, Paris, France
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Aya AG, Ducloy-Bouthors AS, Rugeri L, Gris JC. [Anesthetic management of severe or worsening postpartum hemorrhage]. ACTA ACUST UNITED AC 2014; 43:1030-62. [PMID: 25447392 DOI: 10.1016/j.jgyn.2014.10.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
INTRODUCTION Risk factors of maternal morbidity and mortality during postpartum hemorrhage (PPH) include non-optimal anesthetic management. As the anesthetic management of the initial phase is addressed elsewhere, the current chapter is dedicated to the management of severe PPH. METHODS A literature search was performed using PubMed and Medline databases, and the Cochrane Library, for articles published from 2003 up to and including 2013. Several keywords related to anesthetic and critical care practice, and obstetrical management were used, in various combinations. Guidelines from several societies and organisations were also read. RESULTS When PPH worsens, one should ask for additional team personnel (professional consensus). Patients should be monitored for heart rate, blood pressure, skin and mucosal pallor, bleeding at skin puncture sites, diuresis and the volume of genital bleeding (grade B). Because of the possible rapid worsening of coagulapathy, patients should undergo regular evaluation of coagulation status (professional consensus). Prevention and management of hypothermia should be considered (professional consensus), by warming intravenous fluids and blood products, and by active body warming (grade C). Antibiotics should be given, if not already administered at the initial phase (professional consensus). Vascular fluids must be given (grade B), the choice being left at the physician discretion. Blood products transfusion should be decided based on the clinical severity of PPH (professional consensus). Priority is given to red blood cells (RBC) transfusion, with the aim to maintain Hb concentration>8g/dL. The first round of products could include 3 units of RBC (professional consensus), and the following round 3 units of RBC, and 3 units of fresh frozen plasma (FFP). The FFP:RBC ratio should be kept between 1:2 and 1:1 (professional consensus). Depending on the etiology of PPH, the early administration of FFP is left at the discretion of the physician (professional consensus). Platelet count should be maintained at>50 G/L (professional consensus). During massive PPH, fibrinogen concentration should be maintained at>2g/L (professional consensus). Fibrinogen can be given without prior fibrinogen measurement in case of massive bleeding (professional consensus). General anesthesia should be considered in case of hemodynamic instability, even when an epidural catheter is in place (professional consensus). CONCLUSION The anesthetic management aims to restore and maintain optimal respiratory state and circulation, to treat coagulation disorders, and to allow invasive obstetrical and radiologic procedures. Clinical and instrumental monitoring are needed to evaluate the severity of PPH, to guide the choice of therapeutic options, and to assess treatments efficacy.
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Affiliation(s)
- A G Aya
- Département anesthésie-douleur, groupe hospitalo-universitaire Caremeau, place du Pr.-Debré, 30029 Nîmes cedex 09, France; EA2992, faculté de médecine Montpellier-Nîmes, 186, chemin du Carreau-de-Lanes, 30029 Nîmes cedex 2, France.
| | - A-S Ducloy-Bouthors
- Pôle d'anesthésie-réanimation, CHU Lille, 2, avenue Oscar-Lambret, 59037 Lille, France
| | - L Rugeri
- Unité d'hémostase clinique, hôpital Édouard-Herriot, pavillon E 5, place d'Arsonval, 69003 Lyon, France
| | - J-C Gris
- Laboratoire et consultations d'hématologie, groupe hospitalo-universitaire Caremeau, place du Pr.-Debré, 30029 Nîmes cedex 09, France; EA2992, faculté de médecine Montpellier-Nîmes, 186, chemin du Carreau-de-Lanes, 30029 Nîmes cedex 2, France
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Lonjaret L, Lairez O, Minville V, Bayoumeu F, Fourcade O, Mercier F. Embolie pulmonaire et grossesse. ACTA ACUST UNITED AC 2013; 32:257-66. [DOI: 10.1016/j.annfar.2013.01.024] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2012] [Accepted: 01/22/2013] [Indexed: 10/27/2022]
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Le rapport 2003–2005 sur la mortalité maternelle au Royaume-Uni : commentaires et comparaison aux données françaises. ACTA ACUST UNITED AC 2009; 28:38-43. [DOI: 10.1016/j.annfar.2008.11.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2008] [Accepted: 11/05/2008] [Indexed: 11/17/2022]
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Bandaly F, Chaar J, Asmar G, Bardiau Y, Sayegh A, Amirault P. Thrombophlébite de la veine ovarienne du postpartum : une urgence à ne pas méconnaître. ACTA ACUST UNITED AC 2008. [DOI: 10.1016/j.jeur.2009.02.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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