Severity of shock, rate of physiological stabilization and organ failure in healthy women admitted to the intensive care unit following major peripartum hemorrhage: A retrospective, descriptive study

Purpose: To describe shock severity, physiological stabilization and organ failure in healthy women admitted to the intensive care unit (ICU) after major peripartum hemorrhage (PPH). Materials and methods: Retrospective, descriptive, single center study. Results: Twenty-nine women median age 33 years (interquartile range [IQR] 30–36) and gravidity 5 pregnancies (IQR 3–9) were studied. One woman died. The median maternal admission hematocrit was 28.8 (IQR 25.7–32.4). Median transfusion rates were nine units of packed red blood cells (IQR 7–12.25), eight fresh frozen plasma (IQR 6–12), 17 platelets (IQR 10–22) and 15 cryoprecipitate (IQR 9.75–20). Blood pressure dropped significantly in the six hours following ICU admission. Nonetheless, lactate decreased from 3.23 mmol/L to 1.54 mmol/L within 24 h of ICU admission, renal and pulmonary function were unaffected and coagulopathy was never observed. Two-thirds of the women underwent hysterectomy. One-third underwent repeated surgery. The median length of ICU stay was <48 h and that of mechanical ventilation was <24 h. Increased transfusion rates correlated with lengthier ICU admission (p ≤ 0.01 regardless of blood product). Conclusions: Ongoing hemorrhage in women with severe PPH manifests subtly and often requires active intervention. Hemorrhage control is required to achieve physiological stabilization and minimize organ damage.