Features and Characteristics of the Maternal Coagulation System During Cesarean Sections
- Author:
Narantsatsralt D
1
;
Lkhagvasuren J
Author Information
1. 1st maternity home
- Publication Type:Journal Article
- Keywords:
Coagulation;
cesarean sections;
multiparae;
activated recalcifi cation time;
hemostasia
- From:Mongolian Medical Sciences
2009;148(2):2-5
- CountryMongolia
- Language:Mongolian
-
Abstract:
As Mongolia is one of the countries with a high maternal mortality rate, the main goal of the Ministry of Health is to reduce the maternal mortality rate. According to the 2005 social survey, Mongolias average population growth reached 1.5 percent and 50.4 percent of the population are females including those of reproductive age making up 28.3 percent. Health and sociological surveys conducted in recent years have shown that the number of multiparae and multigravidae is unlikely to fall in the coming years, probably in the next 10 years. The lack of studies of hemostasia and hemodynamic in multiparae who underwent Cesarean sections has served as the grounds for this research. Goal The goal of this research is to develop a method of preventing surgical complications by studying the causes and characteristics of Cesarean sections in multiparae. Objectives: 1. To do a comparative study of changes in hemodynamic and hemostasia before, during, and after Cesarean sections and process the results, 2. To evaluate laboratory test results during Cesarean sections in multiparae. Methodology 1. Research Materials: Analysis materials are the laboratory samples and birth histories of mothers having Cesarean sections. 2. Research Methodology 3. Sampling Frame: The study will involve mothers (approximately 70 mothers) who are hospitalized in Maternal Departments 1 and 2 of the Clinical Maternity Hospital No. 1 and who will be delivered of their children by Cesarean sections. 4. To study the characteristics of Maternal Coagulation System and to do a selective comparison to the result. Results We have made an analysis to determine the indicators of the erythrocytes and coagulation systems before, during, and after sections in order to study the changes taking place in hemodynamic and hemostasia for discovering the changes in the coagulation systems of multiparae. Our research has identifi ed the following indicators of coagulation: clotting time, activated decalcifi cation time, artifi cially activated thromboplastin time, and fi brinogen amount. Each indicator of the test takes part in a particular stage of clotting and indicates failure of clotting factors or dysfunction of particular stages. According to the analysis, the clotting time in multiparae accelerates 1.5 times more than in prima gravidae, creating over clotting of blood. It indicates that the members of this group should be included in a group with a high risk of thromboembolism. The average level of the artifi cially activated thromboplastin time in prima gravidae was 32.24.6 before sections, 32.74.8 during sections, and 383.4 on the second day after sections, while multiparae had 39.73.4 seconds before sections, 37.34.4 seconds during sections, and 35.73.4 seconds on the second day after sections. It shows that these two indicators have no dramatic changes in prima gravidae, but they are shortened in multiparae during all stages of sections, proving a risk of thromboembolism. During normal pregnancy, both fi brinogen and its procoagulant level increase, reaching the maximum level before delivery, and therefore, the protein level is usually high during normal pregnancy. That is to say, changes in the coagulation system are directly dependent (P=0.01). Discussion Some Mongolian researchers who have studied the coagulation system disorders concluded that all indicators of clotting reach their maximum levels at the end of pregnancy and cause over clotting of blood through adaptation mechanisms.Our study has shown that these women have certain infl ammations or clotting disorders, since their pregnancy continues together with obstetrical or system disorders. During our research, the tests for the artifi cially activated thromboplastin time and the activated recalcifi cation time have determined the over clotting of blood, in particular the activity of the internal tract of hemostasia, and identifi ed a risk of thromboembolism. These results are similar to those of the studies conducted by A.Ts. Makatseriya (1997), and Sh.Sh. Rajabova (1997), and other scientists of the Dagestan University. Conclusion 1. Compared to those in the prima gravidae who had Cesarean sections, the artifi cially activated thromboplastin time and the activated recalcifi cation time in the multiparae who have had Cesarean sections fall signifi cantly (P=0.01), and this proves a high risk of thromboembolism. The above mentioned two groups have different fi brinogen levels. The fact that the fi brinogen level in the multiparae increases during and after the sections proves that pregnancy continues together with system or obstetrical disorders. 2. Multiparae belong to a high-risk group. If these women receive antenatal care as early as possible and timely complex measures are taken to reveal and cure system disorders in the mothers and normalize the changes taking place in hemodynamics and hemostasia. It is possible to prevent potential complications during or after sections and reduce maternal and fetal mortality rates.
