Basic parameters of hemostasis in patients with refractory postpartum hemorrhage
https://doi.org/10.23946/2500-0764-2025-10-2-44-55
Abstract
Aim. To study the types of vaginal microbial communities in women with high-grade squamous intraepithelial lesion (HSIL) and those negative for intraepithelial lesion or malignancy (NILM). Materials and Methods. Between 2021 and 2023, we conducted an analysis of vaginal microbial community types among 70 women of reproductive age infected with high-risk oncogenic HPV: those with HSIL verified by cytological examination (n = 40) and those without precancerous cervical lesions (i.e., NILM, n = 30). Identification of microorganisms in the cervical mucus was identified by mass spectrometry. Results. The frequency of normal microbiota detected by the microscopic examination was 5.3-fold lower, whilst Streptococcus spp. was detected 3-fold times higher in women with HSIL compared to the NILM group (p = 0.023). Among patients with HSIL, community state type (CST) IV was the most frequent (75%), and CST IV-C1 subtype (with Streptococcus spp. as a prevailing genus) was found in 25% of cases (p = 0.132). In patients with NILM, CST IV was also the predominant type (60%) but CST IV-C2 (with Enterococcus spp. as a prevailing genus) was most frequent subtype (23.3%, p = 0.087). The prevalence of HPV type 16 and grade 2 abnormal colposcopy findings were 3.9-fold (p = 0.008) and 3.5-fold (p = 0.040) higher in women with HSIL than in NILM (p = 0.008). Conclusion. The predominant type among vaginal microbial communities in women with HSIL and NILM was CST IV, with C1 and C2 subtypes prevailing respectively in HSIL and NILM
About the Authors
D. A. ArtymukRussian Federation
Dr. Dmitry A. Artymuk, MD, Obstetrician-Gynecologist
Bakinskaya Street, 26, Moscow, 115516
N. A. Artymuk
Russian Federation
Prof. Natalia V. Artymuk, MD, Dr. Sci. (Medicine), Professor, Head of the Department of Obstetrics and Gynecology named after prof. G.A. Ushakova
Voroshilova Street, 22a, Kemerovo, 650056
T. Yu. Marochko
Russian Federation
Dr. Tatiana Yu. Marochko, MD, Cand. Sci. (Medicine), Associate Professor, Department of Obstetrics and Gynecology. prof. G.A. Ushakova
Voroshilova Street, 22a, Kemerovo, 650056
A. V. Atalyan
Russian Federation
Dr. Alina V. Atalyan, Cand. Sci. (Biology), Senior Researcher, Head of the Functional Group of Information Systems and Biostatistics
Timiryazeva Street, 16, Irkutsk, 664003
N. M. Shibelgut
Russian Federation
Dr. Nonna M. Shibelgut, MD, Cand. Sci. (Medicine), Deputy Chief Physician for Obstetric Care
Oktyabrskiy Prospekt, 22, Kemerovo, 650066
N. A. Batina
Russian Federation
Dr. Natalia A. Batina, MD, Head of the Maternity Department
Oktyabrskiy Prospekt, 22, Kemerovo, 650066
V. N. Palichev
Russian Federation
Dr. Vasiliy N. Palichev, MD, Head of the Resuscitation and Anesthesiology Department
Oktyabrskiy Prospekt, 22, Kemerovo, 650066
S. V. Apresyan
Russian Federation
Prof. Sergey V. Apresyan, MD, Dr. Sci. (Medicine), Professor, Department of Obstetrics and Gynecology
Miklukho-Maklaya Street, 6, Moscow, 117198
References
1. Overton E, D'Alton M, Goffman D. Intrauterine devices in the management of postpartum hemorrhage. Am J Obstet Gynecol. 2024;230(3S):S1076– S1088. https://doi.org/10.1016/j.ajog.2023.08.015
2. Andrikopoulou M, D'Alton ME. Postpartum hemorrhage: early identification challenges. Semin Perinatol. 2019;43(1):11–17. https://doi.org/10.1053/j.semperi.2018.11.003
3. Artymuk DA, Apresyan SV, Artymuk NV, Marochko TYu, Shibelgut NM, Batina NA. An Integrated Approach to the Prevention of Postpartum Bleeding in High-Risk Patients. Fundamental and Clinical Medicine. 2024;9(2):55–65. (In Russ.). https://doi.org/10.23946/2500-0764-2024-9-2-55-65
4. Liu LY, Nathan L, Sheen JJ, Goffman D. Review of Current Insights and Therapeutic Approaches for the Treatment of Refractory Postpartum Hemorrhage. Int J Womens Health. 2023;15:905–926. https://doi.org/10.2147/IJWH.S366675
5. Cannata G, Mariotti Zani E, Argentiero A, Caminiti C, Perrone S, Esposito S. TEG® and ROTEM® Traces: Clinical Applications of Viscoelastic Coagulation Monitoring in Neonatal Intensive Care Unit. Diagnostics (Basel). 2021;11(9):1642. https://doi.org/10.3390/diagnostics11091642
6. Akselrod BA, Dymova OV, Guskov DA, Goncharova AV, Gladysheva VG, Tolstova IA, et al. Thromboelastometry for predicting hemostasis disorders after cardiopulmonary bypass during cardiac surgery. Russian journal of hematology and transfusiology. 2023;68(1):50–61. (In Russ.). https://doi.org/10.35754/0234-5730-2023-68-1-50-61
7. Ronenson AM, Shifman EM, Kulikov AV, Raspopin YuS. Reference values of rotational thromboelastometry in pregnancy and parturition: a systematic review and meta-analysis. Russian Journal of Anesthesiology and Reanimatology. 2021;(3):28–40. (In Russ.). https://doi.org/10.17116/anaesthesiology202103128
8. de Moreuil C, Mehic D, Nopp S, Kraemmer D, Gebhart J, Schramm T, et al. Hemostatic biomarkers associated with postpartum hemorrhage: a systematic review and meta-analysis. Blood Adv. 2023;7(19):5954–5967. https://doi.org/10.1182/bloodadvances.2023010143
9. Yilmaz EPT, Celik Y, Topdagi YE, Guzel AI, Al RA. New approach to the risk variables for administration of fibrinogen in patients with postpartum hemorrhage by using cluster analysis. Int J Gynaecol Obstet. 2021;152(2):256–261. https://doi.org/10.1002/ijgo.13386
10. Artymuk NV, Marochko TYu, Artymuk DA, Apresyan SV, Kolesnikova NB, Atalyan AV, et al. Hemostasis as a risk factor for refractory postpartum hemorrhage. Doctor.Ru. 2024;23(5):43–49. (in Russ.). https://doi.org/10.31550/1727-2378-2024-23-5-43-49
11. Salomon C, de Moreuil C, Hannigsberg J, Trémouilhac C, Drugmanne G, Gatineau F, et al. Haematological parameters associated with postpartum haemorrhage after vaginal delivery: Results from a French cohort study. J Gynecol Obstet Hum Reprod. 2021;50(9):102168. https://doi.org/10.1182/bloodadvances.2023010143
12. Qi S, Fu X. Establishment of a predictive model for postpartum hemorrhage in twins: a retrospective study. BMC Pregnancy Childbirth. 2023;23(1):644. https://doi.org/10.1186/s12884-023-05933-7
13. Khanna P, Sinha C, Singh AK, Kumar A, Sarkar S. The role of point of care thromboelastography (TEG) and thromboelastometry (ROTEM) in management of Primary postpartum haemorrhage: A meta-analysis and systematic review. Saudi J Anaesth. 2023;17(1):23–32. https://doi.org/10.4103/sja.sja_529_22
14. Deppe AC, Weber C, Zimmermann J, Kuhn EW, Slottosch I, Liakopoulos OJ, et al. Point-of-care thromboelastography/thromboelastometry-based coagulation management in cardiac surgery: a meta-analysis of 8332 patients. J Surg Res. 2016;203(2):424–433. https://doi.org/10.1016/j.jss.2016.03.008
15. McNamara H, Mallaiah S. Managing coagulopathy following PPH. Best Pract Res Clin Obstet Gynaecol. 2019;61:106–120. https://doi.org/10.1016/j.bpobgyn.2019.04.002
16. Collins PW, Bell SF, de Lloyd L, Collis RE. Management of postpartum haemorrhage: from research into practice, a narrative review of the literature and the Cardiff experience. Int J Obstet Anesth. 2019;37:106– 117. https://doi.org/10.1016/j.ijoa.2018.08.008
17. Agarwal S, Laycock HC. The debate ROTEMs on - the utility of point-ofcare testing and fibrinogen concentrate in postpartum haemorrhage. Anaesthesia. 2020;75(9):1247–1251. https://doi.org/10.1111/anae.15193
18. Curry NS, Davenport R, Pavord S, Mallett SV, Kitchen D, Klein AA, et al. The use of viscoelastic haemostatic assays in the management of major bleeding: A British Society for Haematology Guideline. Br. J. Haematol. 2018;182(6):789-806. https://doi.org/10.1111/bjh.15524
19. Galstyan GM, Gaponova TV, Zhiburt EB, Balashova EN, Berkovskiy AL, Bystrykh OA, et al. Clinical guidelines for cryoprecipitate transfusions. Russian journal of hematology and transfusiology. 2020;65(1):87–114. (In Russ.). https://doi.org/10.35754/0234-5730-2020-65-1-87-114
20. Shin HJ, Nam SW, Koo BW, Kim J, Hwang JW, Do SH, et al. Na HS. Rotational thromboelastometry during Cesarean section as a predictive evaluation for the progression of persistent postpartum hemorrhage in parturients with placenta previa: A prospective observational study. Heliyon. 2023;9(2):e13563. https://doi.org/10.1016/j.heliyon.2023.e13563
21. Gruneberg D, Hofer S, Schöchl H, Zipperle J, Oberladstätter D, Decker SO, et al. Comparison of Two Viscoelastic Testing Devices in a Parturient Population. J Clin Med. 2024;13(3):692. https://doi.org/10.3390/jcm13030692.
Review
For citations:
Artymuk D.A., Artymuk N.A., Marochko T.Yu., Atalyan A.V., Shibelgut N.M., Batina N.A., Palichev V.N., Apresyan S.V. Basic parameters of hemostasis in patients with refractory postpartum hemorrhage. Fundamental and Clinical Medicine. 2025;10(2):44-55. (In Russ.) https://doi.org/10.23946/2500-0764-2025-10-2-44-55