The state of systemic oxygen transport depending on the hematocrit and hemoglobin values in an intrapartum hemorrhage

Authors

  • D.S. Мityuryev Shupyk National Healthcare University, Kyiv, Ukraine; Municipal Institution of Lviv Regional Council “Lviv Regional Clinical Perinatal Center”, Lviv, Ukraine
  • O.A. Loskutov Shupyk National Healthcare University, Kyiv, Ukraine https://orcid.org/0000-0002-7646-9193
  • A.A. Zezer Shupyk National Healthcare University, Kyiv, Ukraine; ME KRC “Kyiv Regional Clinical Hospital”, Kyiv, Ukraine

DOI:

https://doi.org/10.22141/2224-0586.18.2.2022.1477

Keywords:

massive obstetric hemorrhage, systemic oxygen transport, hemoglobin minimal value

Abstract

Background. Massive obstetric hemorrhage (MOH) is the most common cause of maternal mortality worldwide. There are currently a lot of national guidelines for MOH mana­gement, but the guidelines provided do not grant reasonable guidance on the minimum acceptable hemoglobin (Hb) level, which ensures the minimum acceptable oxygen delivery (IDO2). The work was aimed to assess the state of systemic oxygen transport depending on hematocrit and Hb in terms of blood loss, and to determine the minimum acceptable level of Hb, which provides an adequate relationship between systemic oxygen transport and oxygen needs in the development of MOH. Materials and methods. The study included 113 mothers in whom childbirth was complicated by blood loss. The mean age of parturient women was 32.5 ± 6.4 years, mean weight — 76.5 ± 12.4, mean gestational age — 39.5 ± 1.5 weeks. The dominant causes of MOH were uterine atony (52.14 %), ute­rine inversion (15.38 %), and amniotic fluid embolism (10.26 %). Less frequently, blood loss was observed due to uterine rupture (5.98 %), placental abruption (5.98 %), placenta previa (5.98 %), and delayed placental abruption (4.27 %). Postpartum blood loss ave­raged 1830.5 ± 622.7 ml (1200 to 2500 ml). The bleeding in all cases was stopped according to current protocols. Results. With Ht values ranging from 20.0 to 28.9 %, and Hb 45.1–68.9 g/l and the same FiO2 accounted for 100 %, the deviation of IDO2 was 2–3 times lower than the normal state of the gas transport blood function and only in patients with Ht 29.0–30.0 % and Hb 70.1–79.9 g/l, IDO2 values were close to the physiological norm. At Ht levels of 20.0–22.9 %, and Hb 45.1–50.4 g/l, the systemic oxygen consumption index was twice less than the generally accepted physiological norms, and in patients with the level of Ht 29.0–30.0 %, and Hb 70.1–79.9 g/l, the values of this indicator were within normal li­mits. At Ht levels ranged from 20.0 to 25.9 %, and Hb 45.1–60.2 g/l, tissue oxygen extraction rates were 1.5–2 times higher than gene­rally accepted physiological norms, and in patients with Ht 29.0–30.0 %, and Hb 70.1–79.9 g/l, its values were within normal limits. When calculating the minimum accep­table value of Hb in parturient women in the conditions of blood loss by linear regression with the calculation of coefficients by the method of the least squares, the obtained Hb values of 82.5365 g/l were consi­dered minimally acceptable when functional heart state and oxygen exchange are at the mi­nimum threshold of the physio­logical norm.

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References

GBD 2015 Disease and Injury Incidence and Prevalence Collaborators. Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet. 2016 Oct 8;388(10053):1545-1602. doi:10.1016/S0140-6736(16)31678-6.

Kayem G, Dupont C, Bouvier-Colle MH, Rudigoz RC, Deneux-Tharaux C. Invasive therapies for primary postpartum haemorrhage: a population-based study in France. BJOG. 2016 Mar;123(4):598-605. doi:10.1111/1471-0528.13477.

Collis R, Guasch E. Managing major obstetric haemorrhage: Pharmacotherapy and transfusion. Best Pract Res Clin Anaesthesiol. 2017 Mar;31(1):107-124. doi:10.1016/j.bpa.2017.02.001.

Weeks A. The prevention and treatment of postpartum haemorrhage: what do we know, and where do we go to next? BJOG. 2015 Jan;122(2):202-210. doi:10.1111/1471-0528.13098.

Lier H, von Heymann C, Korte W, Schlembach D. Peripartum Haemorrhage: Haemostatic Aspects of the New German PPH Guideline. Transfus Med Hemother. 2018 Apr;45(2):127-135. doi:10.1159/000478106.

Rani PR, Begum J. Recent Advances in the Management of Major Postpartum Haemorrhage - A Review. J Clin Diagn Res. 2017 Feb;11(2):QE01-QE05. doi:10.7860/JCDR/2017/22659.9463.

Shaylor R, Weiniger CF, Austin N, et al. National and International Guidelines for Patient Blood Management in Obstetrics: A Qualitative Review. Anesth Analg. 2017 Jan;124(1):216-232. doi:10.1213/ANE.0000000000001473.

Riabov GA. Gipoksiia kriticheskikh sostoianii [Hypoxia of critical states]. Moscow: Meditsina; 1988. 288 p. (in Russian).

Ministry of Нealth of Ukraine. Order on March 24, 2014 № 205. On Amendments to the Orders of the Ministry of Health of Ukraine on December 29, 2005 № 782 and on December 31, 2004 № 676. Available from: https://zakon.rada.gov.ua/rada/show/v0205282-14#Text. Accessed: March 24, 2014. (in Ukrainian).

Chambers D, Huang C, Matthews G. Basic Physiology for Anaesthesists. 2nd ed. Cambridge, UK: Cambridge University Press; 2019. 321 р.

Published

2022-04-30

How to Cite

Мityuryev D., Loskutov, O., & Zezer, A. (2022). The state of systemic oxygen transport depending on the hematocrit and hemoglobin values in an intrapartum hemorrhage. EMERGENCY MEDICINE, 18(2), 66–72. https://doi.org/10.22141/2224-0586.18.2.2022.1477

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