I nā wahine maʻamau, ua hoʻololi nui ʻia ka hana coagulation, anticoagulation a me fibrinolysis i ke kino i ka wā o ka hāpai ʻana a me ka hānau ʻana, hoʻonui ka ʻike o ka thrombin, coagulation factor a me fibrinogen i ke koko, nāwaliwali nā hana anticoagulation a me fibrinolysis, a aia ke koko i loko o kahi. kūlana hypercoagulable.Hāʻawi kahi hoʻololi physiological i kumu waiwai no ka hemostasis postpartum wikiwiki a maikaʻi.ʻO ka nānā ʻana i ka hana coagulation koko i ka wā o ka hāpai ʻana hiki ke ʻike i nā loli like ʻole i ka hana coagulation koko i ka wā mua, he mea koʻikoʻi ia no ka pale ʻana a me ka hoʻopakele ʻana i nā pilikia obstetric.
I nā wahine hāpai maʻamau, me ka piʻi ʻana o ka makahiki hānau, piʻi ka puʻuwai puʻuwai a hoʻemi ʻia ke kūpaʻa peripheral.Manaʻo nui ʻia e hoʻomaka ka hoʻonui ʻana o ka naʻau ma 8 a 10 mau pule o ka hāpai ʻana a hiki i kahi kiʻekiʻe ma 32 a 34 mau pule o ka hāpai ʻana, he piʻi o 30% a 45% i hoʻohālikelike ʻia me ka hāpai ʻole, a mālama i kēia pae a hiki i ka hānau ʻana.ʻO ka emi ʻana o ke kūpaʻa ʻana o ke kīpē peripheral e hōʻemi i ke kaomi arterial, a emi nui ke koko diastolic, a palahalaha ka ʻokoʻa puʻupuʻu pulse.Mai ka 6 a hiki i ka 10 mau pule o ka hāpai ʻana, piʻi ka nui o ke koko o nā wahine hāpai me ka piʻi ʻana o ka makahiki hānau, a piʻi aʻe ma kahi o 40% i ka hopena o ka hāpai ʻana, akā ʻoi aku ka nui o ka nui o ka plasma ma mua o ka nui o nā ʻulaʻula, plasma. piʻi ka 40% a hiki i ka 50%, a piʻi ka ʻulaʻula ma ka 10% a 15%.No laila, i ka wā hāpai maʻamau, hoʻoheheʻe ʻia ke koko, hōʻike ʻia e like me ka emi ʻana o ka viscosity koko, emi iho ka hematocrit, a me ka piʻi ʻana o ka erythrocyte sedimentation rate.
Hoʻonui nā kumu coagulation koko Ⅱ, Ⅴ, VII, Ⅷ, IX, a me Ⅹ i ka wā o ka hāpai ʻana, a hiki i ka 1.5 a hiki i ka 2.0 mau manawa maʻamau i ka waena a me ka hope o ka hāpai ʻana, a me nā hana o nā kumu coagulation Ⅺ a me emi.ʻO Fibrinopeptide A, fibrinopeptide B, thrombinogen, platelet factor Ⅳ a me fibrinogen i hoʻonui nui ʻia, aʻo ka antithrombin Ⅲ a me ka protein C a me ka protein S i emi iho.I ka wā o ka hāpai ʻana, ua pōkole ka manawa prothrombin a me ka manawa prothrombin i hoʻāla ʻia, a piʻi nui ka plasma fibrinogen content, hiki ke hoʻonui i ka 4-6 g / L i ke kolu o ka trimester, ʻo ia hoʻi he 50% kiʻekiʻe ma mua o ka wahine hāpai ʻole. manawa.Eia kekahi, ua hoʻonui ʻia ka plasminogen, ua hoʻolōʻihi ʻia ka manawa hoʻoheheʻe euglobulin, a ua hoʻololi ka coagulation-anticoagulation i ke kino i kahi kūlana hypercoagulable, i mea e pono ai ka hemostasis maikaʻi ma hope o ka placental abruption i ka wā hana.Eia kekahi, ʻo nā mea hypercoagulable ʻē aʻe i ka wā o ka hāpai ʻana, ʻo ia ka piʻi ʻana o ka cholesterol, phospholipids a me triacylglycerols i loko o ke koko, androgen a me progesterone huna ʻia e ka placenta e hōʻemi i ka hopena o kekahi mau mea hoʻokae koko, placenta, uterine decidua a me nā embryos.ʻO ka loaʻa ʻana o nā mea thromboplastin, a me nā mea ʻē aʻe, hiki ke hoʻoikaika i ke koko i kahi kūlana hypercoagulable, a hoʻonui ʻia kēia hoʻololi me ka piʻi ʻana o ka makahiki hānau.ʻO ka hypercoagulation haʻahaʻa kahi ana palekana physiological, he mea maikaʻi ia e mālama i ka waiho ʻana o ka fibrin i loko o nā aʻa, ka paia o ka ʻōpū a me ka placental villi, kōkua i ka mālama pono ʻana o ka placenta a hoʻokumu i ka thrombus ma muli o ka wehe ʻana, a hoʻomaʻamaʻa i ka hemostasis wikiwiki i ka wā a ma hope o ka hānau ʻana., he hana koʻikoʻi ia e pale ai i ka hemorrhage postpartum.I ka manawa like o ka coagulation, hoʻomaka ka hana fibrinolytic lua e hoʻomaʻemaʻe i ka thrombus i loko o nā ʻāʻī o ka uterine spiral a me nā sinuses venous a hoʻolalelale i ka hana hou a me ka hoʻoponopono ʻana o ka endometrium.
Eia nō naʻe, hiki i kahi kūlana hypercoagulable ke kumu i nā pilikia obstetric.I nā makahiki i hala iho nei, ua ʻike nā haʻawina he nui nā wahine hāpai e maʻalahi i ka thrombosis.ʻO kēia ʻano maʻi o ka thromboembolism i nā wahine hāpai ma muli o nā hemahema genetic a i ʻole nā mea pilikia i loaʻa e like me nā protein anticoagulant, coagulation factor, a me nā protein fibrinolytic i kapa ʻia ʻo thrombosis.(thrombophilia), i ʻike ʻia ʻo ka mokuʻāina prothrombotic.ʻAʻole alakaʻi kēia ʻano prothrombotic i ka maʻi thrombotic, akā hiki ke alakaʻi i nā hopena hāpai ʻino ma muli o ke kaulike ʻole o ka coagulation-anticoagulation mechanisms a i ʻole ka hana fibrinolytic, microthrombosis o ka uterine spiral arteries a i ʻole villus, ka hopena i ka maikaʻi ʻole o ka placental perfusion a i ʻole infarction, e like me Preeclampsia , placental abruption, placental infarction, disseminated intravascular coagulation (DIC), fetal growth restriction, recurrent miscarriage, stillbirth and premature birth, etc., hiki ke alakai i ka make maternal a me ka perinatal i na hihia koʻikoʻi.
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