[Our experince with the use of recombinant activated factor VII in postpartum haemorrhage].

INTRODUCTION: Massive obstetric bleeding is the most common cause of maternal mortality and morbidity. The first step in treatment of these patients is establishing the adequate circulatory volume. The primary goal of therapy is to identify and remove the cause of bleeding, with appropriate symptomatic and substitution therapy. Human recombinant activated factor VII (rFVIIa) is officially registered for the treatment of patients suffering from haemophilia with inhibitors. Its use has also proved successful in other congenital and acquired coagulopathies and in patients with acute non-haemophilic bleeding. A special significance is given to the application of rFVIIa in cases of obstetric haemorrhage, in order to avoid postpartum hysterectomy and occurrence of complications of haemorrhagic shock in obstetrics. OBJECTIVE: The aim of this study is to show our experience and results of the use of rFVIIa in the treatment of patients with massive postpartum bleeding. METHOD: The retrospective study encompassed six patients with primary postpartum haemorrhage treated with rFVIIa at our institution in the period from 2005 to 2007. RESULTS: The treated patients were divided into two groups. In the first group, there were three patients who underwent hysterectomy and who received rFVIIa over 24 hours after delivery. The second group consisted of three patients who received rFVIIa in the first 24 hours after delivery, before we decided to perform hysterectomy. The application of rFVIIa led to successful cessation of bleeding in all patients. Relevant side effects were not registered. CONCLUSION: The administration of rFVIIa in obstetrics should be considered for each patient before decision to apply hysterectomy, and it should certainly be applied in patients who want to preserve the uterus and fertile capability. According to our experience, in cases of postpartum hemorrhagia rFVIIa is to be administered in intravenous bolus doses of at least 90 mcg/kg, at least 6 hours after the onset of bleeding. rFVIIa is not an alternative to adequate surgical haemostasis; therefore, it needs to be administered after its detailed revision.

[Successful application of recombinant activated factor VII in a patient with HELLP syndrome and disseminated intravascular coagulation].

INTRODUCTION: HELLP syndrome represents the form of preeclampsia characterized by moderate hypertension, often with absence of proteinuria and oedema. The frequency of HELLP syndrome in pregnant women with preeclampsia is 10-20%. The clinical course of the disease is characterized by the progressive worsening of mother and fetus condition, which can be stopped only by delivery. Disseminated intravascular coagulation is present in 8% of patients with HELLP syndrome and causes significant morbidity and mortality. CASE OUTLINE: We present a case of HELLP syndrome complicated by intrauterine fetal demise and disseminated intravascular coagulation in trigemelar pregnancy. After all surgical and medicamentous methods to establish haemostasis were exhausted, the patient was treated by recombinant activated factor VII (rFVIIa) in intravenous bolus dose of 90 microg/kg twice, which resulted in satisfactory haemostasis. Side effects of the drug were not registered. CONCLUSION: The application of rFVIIa reduced haemorrhage in our patient, both after the Caesarean section and after hysterectomy, contributing to the patient's full recovery, without neurological sequelae and with preserved renal function. RFVIIa is not an alternative to surgical haemostasis, but its administration should surely be considered before deciding to perform hysterectomy, especially in patients who want to preserve fertility. In cases of postpartum haemorrhage, when bleeding persists even after adequate surgical haemostasis, the administration of rFVIIa is to be considered not only as an alternative to hysterectomy, but also an effort to prevent significant maternal morbidity and mortality.

[Influence of the myocardial bridging phenomenon on the myocardial structure and the coronary arteries wall structure changes].

BACKGROUND/AIM: Our research was performed to evaluate the influences of the myocardial bridgings of coronary arteries on the myocardial and coronary arteries wall structure chages, that could be a reason for multiple heart malfunctions. METHODS: We analyzed the autopsy material, collected during a five-years period, and especially the group of 575 cases with the major aim to diagnose mors naturalis. In all cases with the presence of myocardial bridge over the arterial coronary wall revealed at autopsy, samples were taken for microscopic verification and examination. RESULTS: We found myocardial bridges over the coronary arteries or their major branches in 27 of the cases (4.70%). We believe that myocardial bridges compromise coronary perfusion by cyclic compression of the overbridged vessels, and that it could be the initial factor in the pathogenesis of arteriosclerotic degeneration processes on the coronary artery wall. We found different grades of arteriosclerotic changes in 88.89% of the cases, as well as fibrosis of myocardium in 88.89% and lipomatosis in 66.67% of the cases with the present myocardial bridges. CONCLUSION: Our results suggested that myocardial bridging of coronary arteries and/or their branches was the pathological and even lethal phenomenon that de serves more intensive clinical evaluation.