Assessment of volemic status in postpartum period: a pilot prospective cohort study
Issue 3 (2021) , INTENSIVE CARE IN OBSTETRICS
Issue 3 (2021)
INTENSIVE CARE IN OBSTETRICS

Assessment of volemic status in postpartum period: a pilot prospective cohort study

https://doi.org/10.21320/1818-474X-2021-3-88-97
Published 26.10.2021
Alexander M. Ronenson
Tver Regional Clinical Perinatal Center, Tver, Russia
https://orcid.org/0000-0002-2468-297X
E.M. Shifman
Moscow Regional Research and Clinical Institute, Moscow, Russia
https://orcid.org/0000-0002-6113-8498
A.V. Kulikov
Ural State Medical University, Yekaterinburg, Russia
https://orcid.org/0000-0002-7768-4514
#2021-3
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Keywords

postpartum hemorrhage
blood volume
inferior vena cava
caesarean section
echocardiography

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Ronenson A.M., Shifman E.M., Kulikov A.V. Assessment of volemic status in postpartum period: a pilot prospective cohort study. Annals of Critical Care. 2021;(3):88–97. doi:10.21320/1818-474X-2021-3-88-97.
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Abstract

Introduction. The concept of permissible blood loss during childbirth and during caesarean section (CS) remains a subject of discussion. Also, a controversial issue is the adequacy of the assessment of the volume of blood loss in women in labor based on body weight. Criteria for the appointment of infusion therapy for postpartum hemorrhage (PPH) I–II stage are controversial and require research in this area. Objectives. Determination of the optimal method for assessing blood volume loss to identify women with PPH. Materials and methods. In a pilot prospective cohort study, 30 pregnant, prepared for planned CS. The primary endpoints of the study were the assessment of the volume of blood loss depending on the method of determination, the assessment of TTE and ultrasound of the inferior vena cava in postpartum period after elective CS. Results. Assessment of the volume of blood loss as a percentage of the circulating blood volume revealed 30 % of women with PPH who were not diagnosed by visual assessment, and 16 % of women with PPH who were not diagnosed by gravimetric assessment of the volume of blood loss. Postpartum hemorrhage I–II gr. does not always require replacement fluid therapy. Statistically significant large indices of the collapse index of the inferior vena cava and central hemodynamics indicated a hyperdynamic response of the circulatory system in postpartum women with postpartum hemorrhage due to the redistribution of the water sector. Conclusions. The calculation of the blood volume by the patient’s weight during pregnancy leads to an underestimation of the frequency of PPH of I–II severity in almost every 6 women. The data obtained cast doubt on the existing classification of postpartum hemorrhage depending on the amount of blood loss and require further research in this area to determine the optimal methods for diagnosing the severity of PPH.

https://doi.org/10.21320/1818-474X-2021-3-88-97
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References

  1. Зильбер А.П., Шифман Е.М. Акушерство глазами анестезиолога. «Этюды критической медицины». Петрозаводск: Изд-воПГУ, 1997. Т. 3. [Zilber A.P., Shifman E.M. Obstetrics through the eyes of an anesthesiologist. “Studies in Critical Medicine”. Petrozavodsk: PSU Publishing House, 1997. Vol. 3. (In Russ)]
  2. Pritchard J. Changes in the Blood Volume During Pregnancy and Delivery. Anesthesiology. 1965; 26(4): 393–9. DOI: 10.1097/00000542-196507000-00004
  3. Bernstein I., Ziegler W., Badger G. Plasma volume expansion in early pregnancy. Obstetrics &Gynecology. 2001; 97: 669–72. DOI: 1016/s0029-7844(00)01222-9
  4. РоненсонА.М., Шифман Е.М., Куликов А.В. Волемические и гемодинамические изменения у беременных, рожениц и родильниц. Архив акушерства и гинекологии им. В.Ф. Снегирева. 2018; 5(1): 4–8. DOI: 18821/2313-8726-2018-5-1-4-8 [Ronenson A.M., Shifman E.M., Kulikov A.V. Blood volume and hemodynamic changes in pregnants, parturients and puerperae. V.F. Snegirev Archives of Obstetrics and Gynecology, Russian journal. 2018; 1(5): 4–8. DOI: 10.18821/2313-8726-2018-5-1-4-8 (In Russ)]
  5. Lukaski H., Hall S., William S. Assessment of change in hydration in women during pregnancy and postpartum with bioelectrical impedance vectors. Nutrition. 2007; 23(7–8): 543–50. DOI: 10.1016/j.nut.2007.05.001
  6. de Haas S., Ghossein-Doha C., van Kuijk, S., et al. Physiological adaptation of maternal plasma volume during pregnancy: a systematic review and meta-analysis. Ultrasound Obstet Gynecol. 2017; 49(2): 177–87. DOI: 10.1002/uog.17360
  7. Gyte G.The significance of blood loss at delivery. MIDIRS Midwifery Digest. 1992; 2: 88–92.
  8. Wei Q., Xu Y., Zhang L.Towards a universal definition of postpartum hemorrhage: retrospective analysis of Chinese women after vaginal delivery or cesarean section: A case-control study. Medicine (Baltimore). 2020; 99(33): e21714. DOI: 10.1097/MD.0000000000021714
  9. Gerdessen, L., Meybohm, P., Choorapoikayil, S., et al. Comparison of common perioperative blood loss estimation techniques: a systematic review and meta-analysis. J Clin Monit Comput. 2021; 35: 245–58. DOI: 10.1007/s10877-020-00579-8
  10. Bell S.F., Watkins A., John M., et al. Incidence of postpartum haemorrhage defined by quantitative blood loss measurement: a national cohort. BMC Pregnancy Childbirth. 2020; 20(1): 271. DOI: 10.1186/s12884-020-02971-3
  11. Bienstock J.L., Eke A.C., Hueppchen N.A. Postpartum Hemorrhage. Engl J Med 2021; 384: 1635–45. DOI: 10.1056/NEJMra1513247
  12. Роненсон A.М., Шифман Е.М., Куликов А.В. Тактика инфузионной терапии при послеродовом кровотечении: какие ориентиры выбрать? Анестезиология иреаниматология. 2018; 5: 15–21. DOI: 10.17116/anesthesiology201805115 [Ronenson A.M., Shifman E.M., Kulikov A.V. Infusion therapy strategy for postpartum hemorrhage: what guidelines to choose? Russian Journal of Anaesthesiology and Reanimatology (Anesteziologiya i Reanimatologiya). 2018; 5: 15–21. DOI: 10.17116/anesthesiology201805115 (In Russ)]
  13. Kerr R.S., Weeks A.D. Postpartum haemorrhage: a single definition is no longer enough. BJOG. 2017; 124(5): 723–6. DOI: 10.1111/1471-0528.14417
  14. Lepine S.J., Geller S.E., Pledger M., et al. Severe maternal morbidity due to obstetric haemorrhage: Potential preventability. Aust N Z J Obstet Gynaecol. 2020; 60(2): 212–17. DOI: 10.1111/ajo.13040
  15. КуликовА.В., Шифман Е.М. Анестезия, интенсивная терапия и реанимация в акушерстве и гинекологии. Клинические рекомендации. Протоколы лечения. Изд. 5-е, доп. и перераб. Под ред. А.В. Куликова, Е.М. Шифмана. М.: Поли Принт Сервис, 2020. DOI: 10.18821/9785225100384 [Kulikov A.V., Shifman E.M. Anesthesia, intensive care and resuscitation in obstetrics and gynecology. Clinical guidelines. Treatment protocols. Fifth edition, supplemented and revised. Edited by A.V. Kulikov, E.M. Shifman. Moscow: Poly Print Service,2020. (In Russ)]
  16. Knight M., Bunch K., Tuffnell D., et al. (Eds.) On behalf of MBRRACE-UK. Saving Lives, Improving Mothers’ Care — Lessons learned to inform maternity care from the UK and Ireland Confidential Enquiries into Maternal Deaths and Morbidity 2016–18. Oxford: National Perinatal Epidemiology Unit, University of Oxford. 2020.
  17. Quantitative Blood Loss in Obstetric Hemorrhage: ACOG COMMITTEE OPINION SUMMARY, Number 794. Obstet Gynecol. 2019; 134(6): 1368–9. DOI: 10.1097/AOG.0000000000003564
  18. Vricella L.K., Louis J.M., Chien E., Mercer B.M. Blood volume determination in obese and normal-weight gravidas: the hydroxyethyl starch method. Am J Obstet Gynecol. 2015; 213(3): 408.e1–408.e4086. DOI: 10.1016/j.ajog.2015.05.021
  19. Vricella L.K. Emerging understanding and measurement of plasma volume expansion in pregnancy. The American Journal of Clinical Nutrition. 2017; 106(6): 1620S–1625S. DOI: 10.3945/ajcn.117.155903
  20. Nathan H.L., Seed P.T., Hezelgrave N.L., et al. Shock index thresholds to predict adverse outcomes in maternal hemorrhage and sepsis: A prospective cohort study. Acta Obstet Gynecol Scand. 2019; 98(9): 1178–86. DOI: 10.1111/aogs.13626
  21. Nwafor J.I., Obi C.N., Onuorah O.E., et al. What is the normal range of obstetric shock index in the immediate postpartum period in a low‐resource setting? Int J Gynecol Obstet. 2020; 151: 83–90. DOI: 10.1002/ijgo.13297
  22. Ushida T., Kotani T., Imai K., et al. Shock Index and Postpartum Hemorrhage in Vaginal Deliveries: A Multicenter Retrospective Study. Shock. 2021; 55(3): 332–7. DOI: 10.1097/SHK.0000000000001634
  23. Mok K.L. Make it SIMPLE: enhanced shock management by focused cardiac ultrasound. J Intensive Care. 2016; 4: 51. DOI: 10.1186/s40560-016-0176-x
  24. Millington S.J. Ultrasound assessment of the inferior vena cava for fluid responsiveness: easy, fun, but unlikely to be helpful. Can J Anaesth. 2019; 66(6): 633–8. DOI: 10.1007/s12630-019-01357-0
  25. Старостин Д.О., Кузовлев А.Н. Роль ультразвука в оценке волемического статуса пациентов в критических состояниях. Вестник интенсивной терапии имени А.И. Салтанова. 2018; 4: 42–50. DOI: 10.21320/1818–474X-2018-4-42-50. [Starostin D.O., Kuzovlev A.N. Role of ultrasound in diagnosing volume status in critically ill patients. Alexander Saltanov Intensive Care Herald. 2018; 4: 42–50. (In Russ)]
  26. Zieleskiewicz L, Bouvet L, Einav S, et al. Diagnostic point-of-care ultrasound: applications in obstetric anaesthetic management. Anaesthesia. 2018; 73(10): 1265–79. DOI: 10.1111/anae.14354
  27. Griffiths S.E., Waight G., Dennis AT. Focused transthoracic echocardiography in obstetrics. BJA Educ. 2018; 18(9): 271–6. DOI: 10.1016/j.bjae.2018.06.001
  28. Oba T., Koyano M., Hasegawa J., et al. The inferior vena cava diameter is a useful ultrasound finding for predicting postpartum blood loss. JMatern Fetal Neonatal Med. 2019; 32(19): 3251–4. DOI: 10.1080/14767058.2018.1462321
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