Start Of Bleeding Research Articles

Risk identification for early warning of bleeding among mothers during childbirth

The study was conducted using the observational method. It assessed blood loss using a calibrated measuring cup every 15 minutes in the first hour after delivery and every 30 minutes for the next hour. The results of the analysis showed that the modelling of early warning identification in laboring mothers is influenced by the age and weight of the mother, which is at a significance of 10%. A major warning sign is an increase in blood pressure rate in the third stage of labor which begins 15 minutes from the start of bleeding, and is categorized as dangerous when the blood volume reaches 600 mL. Therefore, every mother in labor must be monitored regularly and continuously and early warning signs must be taken into account. There is no safe time in cases of blood loss. It is very important to identify the risks in a timely manner to identify the source of bleeding so that it can be handled quickly and appropriately in order to prevent complications and maternal death due to postpartum haemorrhage (PPH). Implication, effective and optimal identification in clinical practice should be evidence-based in order to better determine whether or not intervention is needed to prevent blood loss after childbirth.

COMPARISON OF THE EFFECTIVENESS OF FERACRYLUM 1% AND FERACRYLUM 4% IN STOPING BLOODING AFTER GINGIVA INCISION

Background: Bleeding is often found in dental practice. Excessive bleeding can hinder wound healing. For the surgeon to achieve rapid and effective hemostasis is important. Therefore, a topical hemocoagulation solution is given to help control surface bleeding by applying it locally. One such topical agent is Feracrylum. Feracrylum is a polymer of polyacrylic acid containing 0.05 to 0.5% iron. Feracrylum iron element will react with albumin and then convert water-soluble fibrinogen into water-insoluble fibrin which then forms a coagulum. This study aims to compare the effectiveness of Feracrylum 1% and Feracrylum 4% in stopping bleeding after gingival incision. Method: This study is a true experimental study that includes 3 treatment groups, namely the group without being given hemostatic agents, the group being given Feracrylum 1%, and the group being given Feracrylum 4%, each group consisting of 9 rats. Data were collected by calculating the bleeding time from the start of bleeding until the bleeding stopped after the gingival incision using a stopwatch and then recorded. Data analysis using Shapiro-Wilk, homogeneity test using Levene Test, nonparametric test using Kruskal-Wallis and Mann Whitney. Result: The results showed that the average bleeding time in the group without hemostatic agents, the group receiving 1% Feracrylum, and the group receiving Feracrylum 4% was 221 seconds, 103 seconds, and 50 seconds. The results of the Kruskal-Wallis and Mann Whitney showed that there was a significant difference in bleeding time between groups. Conclusion: The conclusion of this study is that the application of Feracrylum 4% was faster in stopping bleeding compared to the application of Feracrylum 1% after gingival incision in wistar rats.

Efficacy of resuscitative infusion with hemoglobin vesicles in rabbits with massive obstetric hemorrhage

Hemoglobin vesicles have been developed as artificial oxygen carriers, and they have the potential to serve as a substitute for red blood cell transfusion. This study aimed to evaluate the efficacy of hemoglobin vesicle infusion for the initial treatment instead of red blood cell transfusion in rabbits with massive obstetric hemorrhage. Pregnant New Zealand white rabbits (28th day of pregnancy; normal gestation period, 29-35 days) underwent uncontrolled hemorrhage to induce shock by transecting the right midartery and concomitant vein in the myometrium. Subsequently, rabbits received isovolemic fluid resuscitation through the femoral vein with an equivalent volume of hemorrhage every 5 minutes. Resuscitative infusion regimens included 5% human serum albumin (n=6), stored washed red blood cells with plasma (vol/vol=1:1; n=5), and hemoglobin vesicle with 5% human serum albumin (vol/vol=4:1; n=5). A total of 60 minutes after the start of bleeding, rabbits underwent surgical hemostasis by ligation of the bleeding vessels and then were monitored for survival within 24 hours. During fluid resuscitation, hemoglobin vesicle infusion and red blood cell transfusion maintained a mean arterial pressure of >50 mm Hg and a hemoglobin concentration of >9 g/dL and prevented the elevation of plasma lactate. In contrast, resuscitation with 5% human serum albumin alone could not prevent hemorrhagic shock as evidenced by a low mean arterial pressure (40 mm Hg), a low hemoglobin concentration (2 g/dL), and a marked elevation of plasma lactate. All animals in the red blood cell group and the hemoglobin vesicle group survived more than 8 hours, whereas all animals in the 5% human serum albumin group died within 8 hours. Hemoglobin vesicle infusion may be effective in the initial management of massive obstetric hemorrhage.

Origins of movements following stunning and during bleeding in cattle

At slaughter, after stunning, the absence of certain physical signs such as eye movements/reflexes or rhythmic breathing helps determine whether the loss of consciousness was actually achieved. Cattle frequently show movements of neck and/or legs during the post-stun period. We evaluated 1) the origins of these movements in stunned unconscious cattle and 2) relationships with presence of ocular signs or breathing and shot characteristics. In stunned unconscious cattle, movements appear to be reflex-like, generated in the brain stem and/or spinal cord. First, in stunned unconscious cattle, movements could continue until 3min after the start of bleeding. Second, severing the spinal cord in stunned unconscious cattle did not influence amount of movements. Third, in reaction to the skin cut and sticking, some unconscious animals showed a nociceptive withdrawal reflex. In bulls, following longer stun-stick delays, this response was weaker. Shot placement, post-stun movements and initial bleeding efficiency seemed related but the underlying mechanisms remain to be elucidated.

Blood in the respiratory tract during slaughter with and without stunning in cattle

Bovine respiratory tracts were examined for blood following shechita without stunning, halal slaughter without stunning, and captive bolt stunning with sticking. In all three methods the cattle were in the upright (standing) position at the start of bleeding. Those that had not been stunned continued to breathe during the early part of bleeding whilst those that were stunned were not breathing. Nineteen percent of the shechita, 58% of the halal and 21% of the stunned plus stuck cattle had blood lining the inner aspect of the trachea. Thirty six percent, 69% and 31% had blood in the upper bronchi, respectively. Ten percent, 19% and 0% had fine bright red blood-tinged foam in the trachea, respectively. It was concluded that concerns about suffering from airway irritation by blood could apply in animals that are either not stunned before slaughter or do not lose consciousness rapidly whilst blood is present in the respiratory tract.

Quantitative trait locus analysis for hemostasis and thrombosis.

Susceptibility to thrombosis varies in human populations as well as many in inbred mouse strains. The objective of this study was to characterize the genetic control of thrombotic risk on three chromosomes. Previously, utilizing a tail-bleeding/rebleeding assay as a surrogate of hemostasis and thrombosis function, three mouse chromosome substitution strains (CSS) (B6-Chr5(A/J), Chr11(A/J), Chr17(A/J)) were identified (Hmtb1, Hmtb2, Hmtb3). The tail-bleeding/rebleeding assay is widely used and distinguishes mice with genetic defects in blood clot formation or dissolution. In the present study, quantitative trait locus (QTL) analysis revealed a significant locus for rebleeding (clot stability) time (time between cessation of initial bleeding and start of the second bleeding) on chromosome 5, suggestive loci for bleeding time (time between start of bleeding and cessation of bleeding) also on chromosomes 5, and two suggestive loci for clot stability on chromosome 17 and one on chromosome 11. The three CSS and the parent A/J had elevated clot stability time. There was no interaction of genes on chromosome 11 with genes on chromosome 5 or chromosome 17. On chromosome 17, twenty-three candidate genes were identified in synteny with previously identified loci for thrombotic risk on human chromosome 18. Thus, we have identified new QTLs and candidate genes not previously known to influence thrombotic risk.

Effects of menstrual cycle on cardiac autonomic innervation as assessed by heart rate variability.

The aim of the study was to investigate the effects of menstrual cycle on cardiac autonomic function parameters in young healthy women by means of heart rate variability (HRV). Forty-three nonobese regularly cycling women (age 29 +/- 6, range 20-38) were enrolled. Recordings for HRV analysis were obtained during the two phases of the menstrual cycle when the estrogen and progesterone levels peaked (follicular phase 11 +/- 1 days and luteal phase 21 +/- 1 days from the start of bleeding). Power spectral analysis of HRV was performed to calculate the low frequency peak (LF, 0.04-0.15 Hz), high frequency peak (HF, 0.15-0.40 Hz), LF in normalized unit (LF nU), HF in normalized unit (HF nU), and LF/HF ratio during the two phases of menstrual cycle. The heart rates, LF and HF, were similar in both phases (P > 0.05). A significant increase was noted in the LF NU in the luteal phase compared to follicular phase of the menstrual cycle (P = 0.014), whereas a tendency for increased HF NU was observed in the follicular phase (P = 0.053). Furthermore, LF/HF ratio was significantly higher in the luteal phase compared to follicular phase (2.1 +/- 1.5 vs 1.6 +/- 0.9, P = 0.002), suggesting increased sympathetic activity in the luteal phase. We concluded that regulation of autonomic tone is modified during menstrual cycle. The alteration in the balance of ovarian hormones might be responsible for these changes in the cardiac autonomic innervation.

Comparison of two HRT regimens with bimonthly and monthly progestin administration in postmenopause

Objectives: Here we report the results of a study in which natural estrogens were given transdermally cyclically and continuously for 1 year, and a progestin of the latest generation, namely nomegestrol acetate, was given for 10 days every month and for 15 days every 2 months. Methods: The patients were a group of 34 post-menopausal women (51–56 years), 18 of whom (group A) were treated with continuous transdermal estradiol (50 μg/day) and cyclic oral nomegestrol at a dose of 5 mg/day for 15 days every 2 months for 1 year. The other 16 women (group B) were treated with cyclic transdermal estradiol for 3 weeks with oral nomegestrol for 10 days (12–21)/month. Endometrial thickness was evaluated by transvaginal ultrasonography before and after treatment. At the end of treatment, an endometrial biopsy was performed. Serum total cholesterol, HDL, LDL and triglycerides were assessed at baseline and every 4 months. The characteristics of the cycle were deduced from the diary cards recorded by the women. Results: No significant differences were found in the mean interval between the last dose of nomegestrol and the start of bleeding or in the duration of bleeding. The total number of days of bleeding per year was significantly lower in group A than group B (27±12 vs 52±18; P<0.01). Total serum cholesterol and LDL significantly decreased after 1 year of treatment in both groups, HDL-cholesterol and triglycerides were found increased at most of the time points studied. Conclusions: The present protocol involving continuous transdermal administration of estrogen combined with oral progestin every 2 months gave good control of the menstrual cycle, did not increase the risk of endometrial pathology and met with good patient compliance.

Changes in the phospholipid composition of cat hepatocyte plasma membrane in hemorrhagic shock

Progressive elimination of phosphatidylcholine from the hepatocyte plasma membranes is observed during the development of hemorrhagic shock in cats. The phosphatidylinositol content decreases 30 min after the start of bleeding and then gradually increases. The phosphatidylethanolamine content is increased on the 30th and 60th min of bleeding, while the content of phosphatidylserine increases 1 h after the start of bleeding. At the peak of hemorrhagic shock the major shifts are observed in the phosphatidylcholine and phosphatidylinositol contents.

Intracerebroventricular angiotensin II increases tolerance to blood loss in conscious sheep.

Intracerebroventricular (i.c.v.) infusion of hypertonic NaCl improves the tolerance to haemorrhage in sheep. Since i.c.v. angiotensin II (ANG II) shares many of the effects of hypertonic NaCl on fluid balance control and blood pressure, we aimed to determine whether i.c.v. ANG II would also be effective in that regard. Six adult conscious ewes were bled from the jugular vein until the mean arterial pressure suddenly dropped to between 45 and 50 mmHg, during an i.c.v. infusion of ANG II (2 pmol kg-1 min-1) which commenced 30 min prior to start of blood removal and continued until end of retransfusion about 80 min after haemorrhage. A corresponding haemorrhage in the same animals during an i.c.v. infusion of 0.9% NaCl served as controls. Significantly more blood had to be withdrawn to induce hypotension when ANG II was given i.c.v. (22.3 +/- 1.8 vs. 12.6 +/- 1.2 mL kg-1). The degree of hypotension and the recovery rate of the blood pressure did not differ between the experiments. The increased tolerance to blood loss by ANG II i.c.v. was accompanied by a reinforced elevation of the systemic vascular resistance and a larger decline of the cardiac output. The plasma norepinephrine concentration was significantly increased immediately after haemorrhage during i.c.v. ANG II, but not in control experiments. The overall vasopressin response to the hypotensive blood loss was not affected by ANG II, but high plasma levels were obtained already during the non-hypotensive stage of haemorrhage. The i.c.v. infusion of ANG II caused a significant lowering of the plasma protein concentration before start of bleeding and accentuated the haemodilution caused by the haemorrhage. We conclude that central administration of ANG II increases the tolerance to haemorrhage in sheep but with concomitant haemodynamic changes which appear unfavourable regarding cardiac load and tissue perfusion.

Regional blood flow in brain and peripheral tissues during acute experimental arterial subdural bleeding.

The effects of a large intracranial arterial subdural bleeding on regional blood flow in the brain (rCBF) and in other body organs were studied, using a porcine model. The bleeding was produced by leading blood through a catheter from the abdominal aorta via an electronic drop recorder into the subdural compartment (SDC) over the left cerebral hemisphere. Pressures in the right lateral cerebral ventricle and in the cisterna magna were recorded along with 15 other vital parameters. Measurements of rCBF were carried out using radioactive microspheres 1) before the start of bleeding, 2) during the early bleeding phase, and 3) during the late bleeding phase. When the bleeding was initiated, the intracranial pressures rose within one minute to a level approximately 40 mmHg below the systemic arterial pressure, whilst the latter usually decreased 30-40 mmHg. In the subsequent early bleeding phase the cerebral perfusion pressure and the bleeding pressure fluctuated at a level of approximately 40 mmHg for several minutes. In the late bleeding phase, the perfusion pressure decreased maximally, even when a Cushing reaction was activated. During the early bleeding phase the changes in rCBF varied between the cerebral regions. However, the mean flow remained largely constant in the presence of a decreasing cerebrovascular resistance, indicating that autoregulation of CBF was intact. Concomitantly, cardiac output and heart rate decreased, whilst regional blood flow in extracerebral organs tended to increase, possibly due to an intracranial effect on the autonomic nervous system. In the late bleeding phase, rCBF was critically reduced in all regions, in spite of a marked rise in systemic arterial pressure.(ABSTRACT TRUNCATED AT 250 WORDS)

PLATEAU-WAVE PHENOMENON (I)

Plateau waves, as described by Lundberg (1960), can often be observed in patients with increased intracranial pressure (ICP) resulting from brain tumours, benign intracranial hypertension and other causes. The clinical significance of the waves, however, is still debated. In this study, the ICP was recorded continuously, the size of the ventricular system was evaluated using computerized tomography (CT), the cerebrospinal fluid (CSF) flow was studied using isotope cisternography, and the absorptive capacity of the CSF was determined by measuring the conductance to CSF outflow, in 94 patients with increased ICP. All patients who received continuous ICP monitorings had a basic ICP level of more than 200 mmHg, and these patients were assigned to two groups on the basis of the presence or absence of the plateau waves in the ICP recordings: group I comprising 17 patients without plateau waves but with a high ICP resulting from subarachnoid haemorrhage or hypertensive intracerebral haemorrhage, within 5 days after the start of bleeding; and group II consisting of 77 patients with both plateau waves and a high ICP resulting from brain tumours, meningitis carcinomatosa, benign intracranial hypertension, superior sagittal sinus thrombosis and communicating hydrocephalus. The isotope cisternography and conductance to CSF outflow studies showed that there was neither a delay in CSF circulation nor an impairment of CSF absorption in the group 1 patients and these patients showed no ventricular dilatation on CT, whereas there was a marked sluggishness in the CSF flow and a severe defect in the CSF absorption capacities of the group II patients irrespective of the presence or absence of ventricular dilatation on CT. The present observations indicate that patients with a plateau-wave phenomenon have a marked impairment of CSF absorption and CSF flow. We suggest that the phenomenon is an important sign indicating an impairment of CSF absorption capacities.

A quantitative study of some factors affecting the outcome of experimental epidural bleeding in swine

During an experimentally induced aggressive epidural bleed the effect on outcome of haematoma volume, cerebral perfusion pressures, intracranial pressure gradients and ventilation were examined in a swine model. Two groups of experiments were performed using either spontaneous ventilation (group 1, n = 6) or mechanical ventilation for 1 hour (group 2, n = 7). The preparations were otherwise identical. An animal was considered to have succumbed when the EEG became irreversibly isoelectric within a total follow-up time of 80 minutes. Mechanical ventilation had a marked effect on survival. All spontaneously ventilated animals succumbed, 4 of them in less than 60 minutes, the remaining 2 between 60 and 80 minutes after the start of bleeding. All mechanically ventilated animals survived for the 60 minutes while the ventilator was connected. Following disconnection 2 animals started to breathe spontaneously and survived the final 20 minutes of the 80 minutes of the follow-up time. The remaining 5 succumbed following apnoea. The size of haematoma did not differ significantly between the groups. Two additional factors, hypoventilation and a secondary rise in supratentorial pressure, contributed to a lethal outcome. Hypoventilation was an inevitable precursor of the isoelectric EEG. There was a close correlation between the development of hypoventilation and intracranial herniation. A secondary rise in supratentorial pressure, unrelated to ventilation, was seen after cessation of bleeding in 8/13 cases. It was associated with a falling supratentorial perfusion pressure and EEG attenuation, suggesting a secondary intracranial expansion, possibly due to oedema, hydrocephalus or both. It is concluded that mechanical ventilation in the acute stage of epidural bleeding may be of clinical value.(ABSTRACT TRUNCATED AT 250 WORDS)

On the role of vasopressin and angiotensin in the development of irreversible haemorrhagic shock.

1. Long-lasting haemorrhagic hypotension (4.5 hr at 35 mmHg) leading to irreversible haemorrhagic shock, has been studied in normal dogs, in dogs treated with a bradykinin potentiating nonapeptide (BPP(9a)), which blocks the conversion of angiotensin I to angiotensin II, and in dogs with experimental chronic diabetes insipidus (DI dogs). BPP(9a) was given by I.V. injection before the start of bleeding (BPP pre-treated group), 45 min after blood pressure had reached 35 mmHg (BPP early treated group) or 2 hr after blood pressure had reached 35 mmHg (BPP late-treated group). After retransfusion of blood all dogs were allowed to recover and observed for a further period of 3 days.2. Untreated control dogs developed haemorrhagic shock with tachycardia, low cardiac output, low total peripheral conductance and low stroke volume. All died within 24 hr of retransfusion, with pathological lesions typical of irreversible haemorrhagic shock.3. BPP pre-treated dogs developed haemorrhagic shock with bradycardia (during early shock), high cardiac output, high peripheral vascular conductance and high stroke volume when compared with the untreated controls. All pre-treated animals survived the 3 day observation period. They were then killed and on post-mortem showed no signs of irreversible haemorrhagic shock.4. BPP early-treated animals behaved like controls before BPP, but like pre-treated animals after the drug. Only one out of eight died within the 3 day observation period.5. BPP late-treated dogs behaved like controls before BPP. They responded to the drug with a rise in cardiac output, peripheral vascular conductance and stroke volume, and with a fall in heart rate. These responses were, however, short-lived. Four out of these eight animals died within the 3 day observation period, with lesions of irreversible haemorrhagic shock.6. DI dogs developed haemorrhagic shock with tachycardia (like controls), but with high cardiac output and peripheral vascular conductance (like BPP pre-treated dogs). The stroke volume of DI dogs was intermediate between those of controls and pre-treated groups. All six dogs survived the 3 day observation period.7. BPP(9a) had no measurable effect on the course of endotoxic shock.8. It is suggested that the normally severe vasoconstriction of the mesenteric vascular bed, which is thought to be responsible for irreversible haemorrhagic shock, is absent or attenuated in the absence of vasopressin or angiotensin. The consequences of this on the development of irreversibility are discussed.