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KMID : 0358419580010020021
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Korean Journal of Obstetrics and Gynecology
1958 Volume.1 No. 2 p.21 ~ p.27
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BLOOD GOAGULATION FEATURE OF A CASE OF ABRUFTIO PLACENTAE AND HYPOFIBRINOGENEMIA
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朴贊武/Park, Chan Moo
申冕雨/尹暎善/Shin, Myun Woo/Yoon, Young Sun
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Abstract
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De Lee made the observation in 19 01 that the blood of patients with abruptio placentae failed to clot, even after several days, and he-described - the conditions as "temporary hemophilia". However the nature of this homphilicphenomenon was not investigated system at ically until recently; The first denonstratio´n´ of the nature of the defect was made in 1936, by Dieckmann who found significantly reduced levels of"blood fibrinogen in patients who hemorrhaged following abruptio placentae; There is no longer any doubt that the hemorrhagic stage which occasionally follows severe cases of abruptio placentae, as well as fetal death. in utero and amniotic fluid embolism is due to the depletion of fibrinogen.
There are two current theories, however, as to the cause of this depletion. either the lysis of fibrinogen by a plasma fibrinolysin or the consumption of fibrinogen that is due to the escape, of placental or decidual thromboplastin into the maternal blood stream. Of two theories, the latter is more readily accepted by many workers, because the fibrinolysis is by no means a constant feature and is absent in some cases asso-ciated with hypofibrinogenemia.
In the ca:e reported in this paper we observed the blood coagulation feature of a patient with partial abruptio placentae, in three different stages -antepartum, immediately after delivery and 22 hours after delivery - who did not chow any overt hemrrhagic condition. The results are as follows : In antepartum, at 7 hours prior to delivery due to initial uterine bleeding, the fibrinogenjevel was slightly reduced, while the prothrombin time was nearly within normal limits, and proth´ombinas well as labile Lc-tot (Facto´ V) were likewise reduced moderately. I umed`ately after aelivery throe was marked fibrinogen depletion and moderate reduction of prothrombin and labile factor, while prothrott´bin time remained at the same level in_antepattum, but none of these reductions was to a degree sufficient to cause hemorrhage. Twenty two hours after delivery all factors, including the fibrinogen, were restored to normal level.
In all three sages, hrweaer, stable factor (Factor Vll) showed an abnormally high level while recalcification time (Calcium clotting time) and heparin tolerance test (Heparin Retarded clotting time) were almost within normal limits, though immediately after delivery they were slightly prolonged.
B_cause of the urgency in cases of abruptio placentae many classical experimental methods are often of more academic interest than of value to the clinician, and several rapid and simple quantitative tests for fibrinogen have been introduced by workers in this field, As to` the treatment of hypofibrinogenemia, for the present we must rely largely upon the use of blood and plasma, Although rational treatment should aim at restoring the fibrinogen,level with fibrinogen injection, depending upon the relative need for red blood cells, we must also realize that with severe fibrinogen depletion many units may be required to re`-otre the clotting power of the blood.
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