Masivna opstetrička krvarenja: narativni pregledni rad

Sandro Glumac, Mate Perković, Neven Elezović

Masivna opstetrička krvarenja učestali su uzrok smrti rodilja u zemljama u razvoju, ali i u razvijenim zemljama. Najnoviji epidemiološki podatci upozoravaju na njihov trend rasta u razvijenim zemljama, što ukazuje na istinsku potrebu za njihovim dubljim razumijevanjem. Stoga je cilj ovoga narativnog preglednog rada na temelju pretraživanja dostupne literature (baze podataka Web of Science [All Databases] i Scopus) čitateljima dati uvid u najnovije dijagnostičke i terapijske pristupe ovome važnom medicinskom problemu. Utvrdili smo kako uterotonici i dalje čine osnovu liječenja te kako su standardni koagulacijski testovi sve manje zastupljeni u dijagnostici, dok je naglasak stavljen na analize „point of care“ poput tromboelastografije i tromboelastometrije. Zaključno, nužno je poznavanje i usvajanje intervencijskih algoritama masivnih opstetričkih krvarenja te uvježban multidisciplinaran pristup u svakom rodilištu.

Massive obstetric hemorrhage is a frequent cause of maternal death in both developing and developed countries. The recent epidemiological data point out its growing incidence in developed countries, which highlights the evident need for further knowledge of this important issue. Thus, the purpose of this narrative review is to summarize and evaluate the latest findings based on the search of available literature (Web of Science (All Databases) and Scopus databases), with special attention paid to the diagnostic and therapeutic approaches to massive obstetric hemorrhage. We determined that uterotonics still form the basis of treatment, and that standard
blood coagulation tests are less common in diagnostics, while emphasis is placed on point-of-care analyses  such as thromboelastography and thromboelastometry. Overall, it is necessary to be familiar and adopt the interventional algorithms of massive obstetric hemorrhage, as well to have a trained multidisciplinary approach in every maternity unit.