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Pulmonary Thromboembolism Complicating Recurrent Placental Abruption at 29 Weeks' Gestation
Author(s) -
Dadelszen Peter,
Peddie David J.
Publication year - 1990
Publication title -
australian and new zealand journal of obstetrics and gynaecology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.734
H-Index - 65
eISSN - 1479-828X
pISSN - 0004-8666
DOI - 10.1111/j.1479-828x.1990.tb03240.x
Subject(s) - placental abruption , medicine , caesarean section , gestation , obstetrics , pregnancy , caesarean delivery , genetics , biology
EDITORIAL COMMENT: We accepted this case for publication mainly because the discussion presents a useful review of the use of heparin in patients with placental abruption. Readers may be interested to know that the editor does not possess the ‘degree of courage’ advocated by Scott (5) in using intrapartum heparin to prevent disseminated intravascular coagulation in patients with severe placental abruption. Although the use of heparin is frequently discussed in such patients, the editor has never seen it used in patients with abruption in his 32 years of obstetric experience. Moreover there was a time in the 1960's when heparinization was used, in selected patients, at the Royal Women's Hospital, Melbourne, to control severe preeclampsia and achieve prolongation of pregnancy Fairley KF, Adey FD, Ross IC, Kincaid‐Smith P. Heparin treatment in severe preeclampsia and glomerulonephritis in pregnancy. Perspect Nephrol Hypertens 1976; 5:103–112., 3 of the 10 patients who presented before 30 weeks, and were treated with heparin, had living babies, but 2 accidental haemorrhages, 1 mild and I severe, both resulting in intrauterine fetal death, occurred in this group of women. As far as the editor can ascertain the occurrence of placental abruption in these patients led to the abandonment of heparin therapy in patients with preeclampsia in this hospital. The use of heparin in patients with glomerulonephritis, with or without associated preeclampsia, is a different problem. In the present report the patient's postoperative heparinization was continued in spite of the development of an abdominal wall haematoma and the need for 14 units of blood. Pulmonary thromboembolism is a risk to life but heparinization also has its problems. We leave it to readers to judge if they would have sterilized the patient, ‘under heparin prophylaxis 6 weeks after completing warfarin therapy’. ABSTRACT A patient with major pulmonary thromboembolism associated with recurrent placental abruption is described. Delivery by Caesarean section was necessary, followed by full heparinization. The use of peripartum heparinization and Caesarean section is reviewed.