Practically from the moment of origin of obstetrics and so far obstetric bleedings remain the huge problem making the main contribution to maternal mortality. According to WHO data obstetric bleedings are the leading cause of death of obstetric patients, considerably advancing hypertensia and septic states.
Obstetric bleedings can arise during any period of pregnancy. They are promoted somewhat by certain changes of a system of blood at pregnancy, namely activation of a coagulant system of blood in a certain situation can lead to fast development of the IDCS. On the other hand, changes from blood promote bigger adaptation to blood loss among pregnant women and also give a little excellent clinical manifestations of blood loss, than in all-surgical practice.
Among the reasons of obstetric bleedings the most frequent is the following: a uterus atony, existence in a uterus of the remains of a placenta, a trauma of patrimonial ways, disturbances from the coagulant system of blood.
At assistance to the patient with obstetric bleeding her competent organization has huge value. Obstetric bleeding is absolutely emergency situation which demands simultaneous participation of many specialists. Creation of the special crews consisting of the head (the administrator of medical institution, his deputy for obstetric aid or the responsible obstetrician-gynecologist), direct organizers of assistance is expedient: heads of obstetric office and office of anesthesiology resuscitation and also employees of obstetric office and office of anesthesiology resuscitation. It is considered that the minimum structure of such crew has to include two obstetricians, two midwifes, one intensivist, two anestezistka, the doctor-laboratory assistant and the medical technologist and two persons from among junior medical staff. The doctor responsible for a transfusion is separately appointed. Participation in assistance to such patients and the staff of profile departments (obstetrics and gynecology and anesthesiology resuscitation) is very desirable. The action plan at obstetric bleeding has to be developed and discussed by the general in advance that among participants of crew there were no disagreements directly in the course of assistance.
For assessment of severity of bleeding use criteria of volume of blood loss and also consider its speed. Blood loss at physiological childbirth up to 0.5% of body weight is considered physiological. More than 0.5% of body weight — pathological and over 1.5% of body weight — massive. At Cesarean section up to 1% — physiological blood loss, more than 1% — pathological and more than 2% — massive. The visual method of assessment of blood loss is often not informative. The gravimetric method is more exact. Calculations of blood loss for special formulas on the basis of a hemoglobin content and a hematocrit are not too exact as their contents is influenced also by the carried-out infusional therapy, besides, at first after the beginning of bleeding concentration indicators of blood can not change. The shock Algovera index is also less informative. It is necessary to consider anamnestic, clinical and datas of laboratory in total. Normal arterial blood pressure at the obstetric patient does not exclude massive blood loss.
At treatment of the patient with obstetric bleeding attention is paid to elimination of a bleeding point and intensive care. At the proceeding bleeding preoperative preparation should not detain the beginning of operation. An anesthesia choice method — the general endotracheal anesthesia with IVL.
Infusional therapy consists of use of crystalloids, synthetic colloids, blood preparations and drugs for correction of a hemostasis. At the same time the share of crystalloids decreases in process of growth of blood loss, with parallel increase in a share of blood preparations. Synthetic colloids, especially on the basis of a dextran and GEK, you should not apply at massive blood loss as they increase the volume of blood loss and can lead to a renal failure.