99: Comparison of management for pregnant women with Delta Storage Pool Deficiency during labor and delivery: a pilot study

Abstract

women with Delta Storage Pool Deficiency during labor and delivery: a pilot study Chao Li, Lanissa Pappas University of Toledo and University of Iowa Hospitals and Clinics, OB/GYN, Iowa City, IA, The Toledo Hospital, Ob/Gyn, Toledo, OH OBJECTIVE: To compare different management of pregnant women with Delta Storage Pool Deficiency ( -SPD)during labor and delivery . STUDY DESIGN: In platelet -granules, small molecules such as ADP, ATP, and serotonin are concentrated. These molecules play an important role in hemostasis. On the floor of labor and delivery, different managements, including hemorrhaging prophylaxis, whether applying epidural and spinal anesthesia were provided to patients in labor with -SPD by different providers. There is no study so far to compare the outcome of different management. In last 5 years, about 30 patients with -SPD were delivered. After chart review, 25 were recruited in this study. The 25 patients all had clear documented diagnosis. Patients’ age, race, gravity, parity, gestational age, pregnancy complications, blood loss, anesthesia, delivery mode and neonatal outcomes were all documented. Different managements and complications were compared. Statistic method: Student T test. Interventional factors applied before regional anesthesia and delivery included platelet transfusion, DDAVP, DDAVP plus Amicar or no intervention. RESULTS: 1. Different interventional factors applied before anesthesia. No complications developed in all the regional anesthesia applied. 2. Different interventional factors applied before spontaneous vaginal delivery in multiparity patients. No difference in estimated blood loss (EBL) was detected. 3. Different interventional factors applied before cesarean section. No difference in EBL was detected. CONCLUSION: With limited data, SPD is not a major bleeding disorder for labor patients. Safety profiles of different managements are all acceptable. It seems DDAVP plus Amicar is an effective treatment during c-section. But further studies with higher power need to be carried out to draw definitive conclusion. 100 Evolution of the invasive procedures rate after the addition of Bakri Balloon as the first second-line therapy in a protocol of severe PPH management Charles Bui, Enora Laas, Thomas Popowski, Patrick Rozenberg Poissy Saint-Germain Hospital, Obstetrics and Gynecology, Poissy, France OBJECTIVE: Postpartum hemorrhage (PPH) is among the most common causes of pregnancy-related death. When uterotonic drugs fail, second-line therapies including artery ligations, compressive uterine sutures or arterial embolization may be performed. Recently, intrauterine balloon tamponade has been proposed as a second-line procedure. Our objective was to study the evolution of the invasive procedures rate after the addition of Bakri Balloon as the first second-line therapy to our protocol of severe PPH management. STUDY DESIGN: We carried out a before and after cohort study in Poissy Saint-Germain Hospital. We compared the outcomes of all patients delivered vaginally with a PPH unresponsive to sulprostone during two equal periods. Medical management of PPH was similar during the 2 periods. However, from September 2006 to March 2008, if bleeding was still not controlled in spite of an infusion of sulprostone, an invasive procedure was at once performed. From April 2008 to December 2010, the intrauterine balloon tamponade was attempted in order to avoid an invasive procedure. RESULTS: The general and obstetrical characteristics of the patients delivered vaginally with a PPH unresponsive to Sulprostone were similar between the 2 periods. Among these, 13.4% (26/194) and 16.0% (35/218, p 0.45) required a second-line therapy during the first and the second period, respectively. During the second period, the Bakri balloon was used in 31 patients delivered vaginally with a success rate of 84% (26/31). The rates of arterial embolizations and conservative surgical procedures (artery ligations, compressive uterine sutures) were significantly reduced in the second period (8.2% vs 2.3%, p 0.006 ; OR 0.26, 95% CI 0.09-0.72 and 5.1% vs 1.4%, p 0.029 ; OR 0.26, 95% CI 0.07-0.95, respectively). No differences were observed in the rate of hysterectomy between the 2 periods. CONCLUSION: In the setting of intractable hemorrhage, balloon tamponade may avoid the need for embolization or conservative surgical procedure with their related risk.