Eclampsia and placental abruption: basic patterns, management and morbidity.

The clinical analysis of 46 cases of abruptio placentae complicating eclampsia showed that, (1) the severity of the eclamptic symptoms influenced the extension of the placental separation, (2) older and multiparous women had more complications, larger placental separations and higher mortality, (3) there were ten maternal deaths due to the additive effects of various complications, (4) total perinatal mortality was 44.7% and it was 40.5% for fetuses above 1000 g, (5) optimum timing of delivery by cesarean operation offered slightly better prognosis, even in cases with antepartum fetal death, (6) the dominant factor for morbidity was the stage reached by the combined pathology before receiving qualified medical care, and (7) the wide variability of these cases suggested that the basis for the complete management should be a series of sound and individually tailored decisions to be carried out in a reasonably short time.

Coagulation and fibrinolysis in molar pregnancy.

Coagulation and fibrinolysis tests were performed in 14 patients with hydatidiform mole before any significant therapy was given and again, after evacuation of the mole, in eight instances. The results were compared with those found in a group of ten volunteers with normal pregnancies. The most frequent abnormalities in the problem cases were a shortening of the partial thromboplastin time and a prolongation of the thrombin time. From a total of seven cases with complete hematologic profiles before and shortly after evacuation of the mole, first showed important drops in platelets and fibrinogen. The most altered profiles occurred after expulsion of the mole in cases with important previous uterine activity. The findings suggested a latent state of hypercoagulability with higher turn over rate of fibrinogen and increased levels of fibrinogen-fibrin degradation products, that may exist even before the mechanism of expulsion begins. It was concluded that the alterations in coagulation and fibrinolysis seen in molar pregnancies most likely have a multifactorial pathogenesis, but the initiating causes must depend on several events taking place in the trophoblast itself and their consequences upon a very distorted intervillous blood circulation.

Abnormal coagulation and fibrinolysis in eclampsia. A clinical and laboratory correlation study.

This study evaluated the existence of abnormally increased coagulation and fibrinolysis in 33 severely toxemic and eclamptic women by means of a combined hemotologic profile with clinical and morphologic correlations. The dominant findings were: different degrees of thrombocytopenia, abnormal levels of blood fibrinogen, prolonged thrombin time, and positive protamine sulfate test. Altered activated partial thromboplastin time and positive ethanol gelation test were slightly less frequent, and only few cases showed prolonged prothrombin time or early lysis of euglobulins. These abnormalities seemed to be more numerous and more pronounced in the worst cases of the series and their severity seemed to be associated with the age of the patient and the presence of previous underlying disease. These variously handicapped pregnant women exhibited worse hematologic hematologic abnormalities, and provided most of the fatal cases in the series. Finally, the main findings were discussed and commented upon.