2025, Number 2-3
Frequency and treatment of obstetric hemorrhage in the puerperium of patients with preeclampsia, who were treated in the Intensive Care Unit of the Gynecology and Obstetrics Hospital of the National Medical Center “La Raza”
Díaz-Aguilar FA, Flores-Espindola NS, Vázquez-Rodríguez JG, Méndez-Yebra MÁ, Mendoza-Reyes E, Tovar-Galván V
Full text
10.35366/122677
Language: Spanish
References: 19
Page: 95-104
PDF size: 340.22 Kb.
ABSTRACT
Introduction: in Mexico, the two main causes of maternal morbidity and mortality are obstetric hemorrhage and hypertensive disorders of pregnancy.Materials and Methods: study design: analytical, observational, descriptive, retrospective, and cross-sectional study in patients diagnosed with obstetric hemorrhage in the puerperium of women with preeclampsia. The records of patients admitted to the intensive care unit (ICU) of the highly specialized gynecology and obstetrics unit of the La Raza National Medical Center from October 2019 to May 2024 were used. Data were collected on demographics, comorbidities, vital signs, laboratory results before and after the hemorrhage, route of pregnancy resolution, amount of hemorrhage, fluids, medical and surgical treatment, transfusions, length of stay in the ICU, use of mechanical ventilation, disseminated intravascular coagulation, and death. Two groups were divided into groups with and without magnesium administration, with mean blood pressure (MAP) less than or greater than 126, and corresponding statistical differences were obtained. Statistical analysis was performed using SPSS25.
Results: sixty patients (8.7%) met the inclusion criteria. The most common age was 35 years, and the gestational age was 34.4 weeks. At the time of admission to intensive care, the median systolic blood pressure was 160 mmHg, and the diastolic blood pressure was 99 mmHg. Neuroprotection with magnesium sulfate was given to 24 patients (40%). The median (M) estimated blood loss at the time of termination of pregnancy was 1,550 ml. The preoperative hemoglobin level was 12.5 g/dl and 10.0 g/dl after surgery, and the platelet level was 163,000 and 117,000, respectively.
The minimum number of milliliters of blood transfused was 250 cc in 11 patients (18.3%) and the maximum was 5,750 ml in 1 patient (1.7%). Fresh frozen plasma (FFP) was used in 19 patients (35.1%), and cryoprecipitate (CP) was used in 14 (23.4%). The use of amines was recorded in 10 patients (17.6%), with invasive mechanical ventilation required in 15 patients (25%). Among the complications reported during their intensive care stay, 9 patients (15%) presented acute kidney injury, 2 (3.3%) presented disseminated intravascular coagulation (DIC), and one death was reported (1.4%).
Comparisons of the two groups with and without magnesium showed statistical significance with the INR (p=0.03) and the PT (p=0.023). Significant differences were found between MAP levels below and above 126, with respect to platelets (p=0.018), PT (p=0.23), and bleeding (p=0.001).
Conclusions: these two conditions in the same patient pose a medical challenge, as the same hypertensive disorders of pregnancy increase the amount of bleeding, and the established treatments differ: antihypertensives are used, while resuscitation is provided with blood products and solutions to improve the hemodynamic status of our patients. The use of magnesium did not show an increase in bleeding, although bleeding did increase with high blood pressure.
REFERENCES
Knight M, Callaghan WM, Berg C, Alexander S, Bouvier-Colle MH,Ford JB, et al. Trends in postpartum hemorrhage in high resourcecountries: a review and recommendations from the International.International Postpartum Hemorrhage Collaborative Group. BMCPregnancy and Childbirth 2009;9:55.doi:10.1186/1471-2393