1
|
da Silva WA, Pinheiro AM, Lima PH, Malbouisson LMS. Renal and cardiovascular repercussions in preeclampsia and their impact on fluid management: a literature review. Braz J Anesthesiol 2021; 71:421-428. [PMID: 33845102 PMCID: PMC9373504 DOI: 10.1016/j.bjane.2021.02.052] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2019] [Revised: 02/15/2021] [Accepted: 02/27/2021] [Indexed: 11/25/2022] Open
Abstract
Preeclampsia is a multifactorial condition associated with significant morbidity and mortality. Fluid therapy in these patients is challenging since volume expansion may precipitate pulmonary edema, and fluid restriction may worsen renal function. Furthermore, cardiac impairment may introduce an additional component to the hemodynamic management. This article reviews the repercussions of preeclampsia on renal and cardiovascular systems and the development of pulmonary edema, as well as to discuss fluid management, focusing on the mitigation of adverse outcomes and monitoring alternatives. The literature review was carried out using PubMed, Embase, and Google Scholar databases from May 2019 to March 2020. Papers addressing the subjects of interest were included regardless of the publication language. There is a current trend towards restricting the administration of fluids in women with non-complicated preeclampsia. However, patients with preeclampsia may experience hemorrhagic shock, requiring volume resuscitation. In this case, hemodynamic monitoring is recommended to guide fluid therapy while avoiding complications.
Collapse
Affiliation(s)
- Wallace Andrino da Silva
- Universidade de São Paulo (USP), Hospital das Clínicas, Faculdade de Medicina, São Paulo, SP, Brazil; Universidade Federal do Rio Grande do Norte (UFRN), Hospital Universitário Onofre Lopes (HUOL), Natal, RN, Brazil.
| | - Aline Macedo Pinheiro
- Universidade Federal do Rio Grande do Norte (UFRN), Hospital Universitário Onofre Lopes (HUOL), Natal, RN, Brazil
| | - Paulo Henrique Lima
- Universidade Federal do Rio Grande do Norte (UFRN), Hospital Universitário Onofre Lopes (HUOL), Natal, RN, Brazil
| | | |
Collapse
|
2
|
Gillissen A, van den Akker T, Caram-Deelder C, Henriquez DDCA, Bloemenkamp KWM, van Roosmalen JJM, Eikenboom J, van der Bom JG. Association between fluid management and dilutional coagulopathy in severe postpartum haemorrhage: a nationwide retrospective cohort study. BMC Pregnancy Childbirth 2018; 18:398. [PMID: 30305108 PMCID: PMC6180574 DOI: 10.1186/s12884-018-2021-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Accepted: 09/24/2018] [Indexed: 01/05/2023] Open
Abstract
Background The view that 2 l of crystalloid and 1.5 l of colloid can be infused while awaiting compatible blood for patients with major postpartum haemorrhage is based on expert opinion documents. We describe real-world changes in levels of coagulation parameters after the administration of different volumes of clear fluids to women suffering from major postpartum haemorrhage. Methods We performed a nationwide retrospective cohort study in the Netherlands among 1038 women experiencing severe postpartum haemorrhage who had received at least four units of red cells or fresh frozen plasma or platelets in addition to red cells. The volume of clear fluids administered before the time of blood sampling was classified into three fluid administration strategies, based on the RCOG guideline: < 2 L, 2–3.5 L and > 3.5 L. Outcomes included haemoglobin, haematocrit, platelet count, fibrinogen, aPTT and PT levels. Results Haemoglobin, haematocrit, platelet count, fibrinogen and aPTT were associated with volumes of clear fluids, which was most pronounced early during the course of postpartum haemorrhage. During the earliest phases of postpartum haemorrhage median haemoglobin level was 10.1 g/dl (IQR 8.5–11.6) among the women who received < 2 L clear fluids and 8.1 g/dl (IQR 7.1–8.4) among women who received > 3.5 L of clear fluids; similarly median platelet counts were 181 × 109/litre (IQR 131–239) and 89 × 109/litre (IQR 84–135), aPTT 29 s (IQR 27–33) and 38 s (IQR 35–55) and fibrinogen 3.9 g/L (IQR 2.5–5.2) and 1.6 g/L (IQR 1.3–2.1). Conclusions In this large cohort of women with severe postpartum haemorrhage, administration of larger volumes of clear fluids was associated with more severe deterioration of coagulation parameters corresponding to dilution. Our findings provide thus far the best available evidence to support expert opinion-based guidelines recommending restrictive fluid resuscitation in women experiencing postpartum haemorrhage. Trial registration Netherlands Trial Register (NTR4079), registration date July 17, 2013. Electronic supplementary material The online version of this article (10.1186/s12884-018-2021-9) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Ada Gillissen
- Center for Clinical Transfusion Research, Sanquin Research, Plesmanlaan 1a - 5th floor, 2333, BZ, Leiden, The Netherlands.,Department of Clinical Epidemiology, Leiden University Medical Center, Albinusdreef 2, 2333, ZA, Leiden, The Netherlands.,Department of Obstetrics, Leiden University Medical Center, Albinusdreef 2, 2333, ZA, Leiden, The Netherlands
| | - Thomas van den Akker
- Department of Obstetrics, Leiden University Medical Center, Albinusdreef 2, 2333, ZA, Leiden, The Netherlands.,National Perinatal Epidemiology Unit, University of Oxford, University of Oxford, Old Road Campus, Oxford, OX3 7LF, UK
| | - Camila Caram-Deelder
- Center for Clinical Transfusion Research, Sanquin Research, Plesmanlaan 1a - 5th floor, 2333, BZ, Leiden, The Netherlands.,Department of Clinical Epidemiology, Leiden University Medical Center, Albinusdreef 2, 2333, ZA, Leiden, The Netherlands
| | - Dacia D C A Henriquez
- Center for Clinical Transfusion Research, Sanquin Research, Plesmanlaan 1a - 5th floor, 2333, BZ, Leiden, The Netherlands.,Department of Clinical Epidemiology, Leiden University Medical Center, Albinusdreef 2, 2333, ZA, Leiden, The Netherlands.,Department of Obstetrics, Leiden University Medical Center, Albinusdreef 2, 2333, ZA, Leiden, The Netherlands
| | - Kitty W M Bloemenkamp
- Department of Obstetrics, Birth Centre Wilhelmina's Children Hospital, University Medical Center Utrecht, Lundlaan 6, 3584, EA, Utrecht, The Netherlands
| | - Jos J M van Roosmalen
- Department of Obstetrics, Leiden University Medical Center, Albinusdreef 2, 2333, ZA, Leiden, The Netherlands.,Athena Institute, VU University Amsterdam, De Boelelaan 1105, 1081, HV, Amsterdam, The Netherlands
| | - Jeroen Eikenboom
- Department of Internal Medicine, Division of Thrombosis and Haemostasis, Leiden University Medical Center, Leiden, the Netherlands
| | - Johanna G van der Bom
- Center for Clinical Transfusion Research, Sanquin Research, Plesmanlaan 1a - 5th floor, 2333, BZ, Leiden, The Netherlands. .,Department of Clinical Epidemiology, Leiden University Medical Center, Albinusdreef 2, 2333, ZA, Leiden, The Netherlands.
| | | |
Collapse
|
3
|
Khaskheli MN, Baloch S, Sheeba A, Baloch S, Khan F, Ansari MR. Acute renal morbidities with obstetrical emergencies: An important women health issue. Pak J Med Sci 2017; 33:594-598. [PMID: 28811777 PMCID: PMC5510109 DOI: 10.12669/pjms.333.12233] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To observe the impact of acute renal morbidities with obstetrical emergencies on maternal health. METHODS In this study pregnant women between 28-40 weeks gestational period and delivered women in their puerperal period up to 42 days after delivery having acute renal problems associated with obstetrical emergencies were included. Pregnant and delivered women with obstetrical emergencies and associated other morbidities were excluded. These women were registered on the predesigned proforma after taking written informed consent and taking approval from institutional ethic research committee. The data was collected and analyzed on SPSS version 21. RESULT Out of these 196 total registered women, majority of these women 81(41.32%) were between 21-30 years of age and multiparous women with parity four and above were 83(42.34%). Commonest presenting symptoms were generalized oedema 123(62.75%) and oligouria 92(46.93%). Frequent obstetrical emergencies observed were pre-eclampsia 53(27.04%), post partum haemorrhage 48(24.48%) and ante partum haemorrhage 36(18.36%) women. The complete recovery was observed in 86(43.87%) women, while mortality was seen in 56(28.57%) women. CONCLUSION Renal morbidities were more frequently observed in obstetrical emergencies leading to high morbidity and mortality rate.
Collapse
Affiliation(s)
- Meharun-Nissa Khaskheli
- Dr. Meharun-Nissa Khaskheli, MBBS, FCPS. Associate Professor, Department of Obstetrics & Gynaecology, Liquat Univeristy of Medical & Health Sciences Jamshoro, Sindh, Pakistan
| | - Shahla Baloch
- Dr. Shahla Baloch, MBBS, DGO, FCPS. Associate Professor, Department of Obstetrics & Gynaecology, Liquat Univeristy of Medical & Health Sciences Jamshoro, Sindh, Pakistan
| | - Aneela Sheeba
- Dr. Aneela Sheeba, MBBS, DMRD, FCPS. Assistant Professor, Department of Radiology, Liquat Univeristy of Medical & Health Sciences Jamshoro, Sindh, Pakistan
| | - Sarmad Baloch
- Dr. Sarmad Baloch, MBBS. House Officer, Medical Department, Liquat Univeristy of Medical & Health Sciences Jamshoro, Sindh, Pakistan
| | - Fahad Khan
- Dr. Fahad Khan, MBBS. House Officer, Medical Department, Liquat Univeristy of Medical & Health Sciences Jamshoro, Sindh, Pakistan
| | - Mohammad Rafique Ansari
- Dr. Mohammad Rafique Ansari, MBBS, FCPS. Assistant Professor, Department of Nephrology, Liquat Univeristy of Medical & Health Sciences Jamshoro, Sindh, Pakistan
| |
Collapse
|
4
|
Morbidly Adherent Placenta: Interprofessional Management Strategies for the Intrapartum Period. J Perinat Neonatal Nurs 2016; 30:319-326. [PMID: 27776031 DOI: 10.1097/jpn.0000000000000209] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
"Morbidly adherent placenta" is a term that describes the continuum of placenta accreta, increta, and percreta. The incidence of this type of abnormal placentation has increased significantly over recent decades. The reason is probably multifactorial but, partly, because of factors such as the increasing number of cesarean births. Women at greatest risk are those who have myometrial damage caused by a previous cesarean birth, with either anterior or posterior placenta previa overlying the uterine scar. This condition poses significant risks of morbidity and/or mortality to the pregnant woman and her fetus. A multidisciplinary approach to care throughout pregnancy is essential. This article describes the classification of morbidly adherent placenta, risk factors, methods of diagnosis, potential maternal and fetal complications, and intrapartum clinical management strategies to optimize outcomes.
Collapse
|
5
|
Abstract
Severe postpartum hemorrhage (PPH) can be defined as a blood loss of more than 1500 mL to 2500 mL. While rare, severe PPH is a significant contributor to maternal mortality and morbidity in the United States and throughout the world. Due to the maternal hematologic adaptation to pregnancy, the hypovolemia resulting from hemorrhage can be asymptomatic until a large amount of blood is lost. Rapid replacement of lost fluids can mitigate effects of severe hemorrhage. Current evidence on postpartum volume replacement suggests that crystalloid fluids should be used only until the amount of blood loss becomes severe. Once a woman displays signs of hypovolemia, blood products including packed red blood cells, fresh frozen plasma, platelets, and recombinant factor VIIa should be used for volume replacement. Overuse of crystalloid fluids increases the risk for acute coagulopathy and third spacing of fluids. A massive transfusion protocol is one mechanism to provide a rapid, consistent, and evidence-based team response to this life-threatening condition.
Collapse
|