The purpose of this study was to increase the effectiveness of intensive care and
reduce the percentage of complications that occur during the development of massive
postpartum bleeding, due to the optimization of intensive care, which is used to treat
the main pathophysiological disorders in case of massive blood loss.
The study was based on a comparative analysis of the effect of proteolysis
inhibitors on the dynamics of blood loss and the development of complications in
massive postpartum bleeding, an assessment of the prognostic role of hemodynamic
parameters in the loss of circulating blood volume in parturient women, and the
determination of the role of lactate in assessing the severity of obstetric bleeding,
assessing the effect of obstetric blood loss on the frequency the occurrence of renal
dysfunction in the early postpartum period and the study of the state of systemic oxygen
transport depending on hematocrit and hemoglobin indicators in conditions of blood
loss.
The study included 117 women in labor, whose childbirth was complicated by
blood loss, who were performed diagnostic, medical procedures and childbirth on the
bases of the Lviv Regional Perinatal Center of the Lviv Regional Council Communal
Institution (Lviv, Ukraine), KRCH "Kyiv Regional Clinical Hospital" (Kyiv, Ukraine).
In view of the wide variety of complications that can arise during the
development of massive postpartum bleeding, in the work they were divided into
separate groups, where each of them is devoted to a separate section, which presents
the analysis, prognostic role and main pathophysiological changes characteristic of this
type of complication.
When evaluating the effectiveness of different dosage regimens of tranexamic
acid (TXA) in the standard protocol of intensive therapy for postpartum hemorrhage
(PPH), four groups of patients were formed: a control group in which a standard
protocol of PPH therapy was used without the use of TXA, and a group using a standard
protocol of PPH therapy with the addition of TXA (group 2 - TXA at a dose of 10
mg/kg, group 3 - TXA at a dose of 25 mg/kg, group 4 - TXA at a dose of 25 mg/kg
with subsequent administration of 10 mg/kg per hour).
During the conducted studies, it was established that the addition of TXA to the
standard protocol of PPH therapy has a significant effect on reducing the volume of
blood loss, but may be accompanied by the occurrence of undesirable side effects,
dose-dependent, such as arrival convulsive activity (up to 18.18% of cases), nausea
(from 6.67% to 18.18% of cases), vomiting (from 3.85% to 12.12% of cases), headache
(from 3.3% to 10.71% of cases), arthralgia and myalgia (from 3.57% to 15.15% of
cases), deep vein thrombosis of the lower extremities, vomiting (from 3.03% to 3.85%
of cases). At the same time, the addition of TXA in a dosage of 10 mg/kg had a smaller
effect compared to TXA in a dosage of 25 mg/kg. The addition of TXA in a dosage of
20 mg/kg was accompanied by a lower frequency of complications compared to the
use of TXA in a dosage of 25 mg/kg + 10 mg/kg, and the optimal dosage of TXA, in
terms of hemostatic effect/frequency of side effects, can be considered a dose of 25
mg/ kg.
To study the prognostic role of hemodynamic parameters, which are used to
assess the reaction of the systemic circulation to the loss of circulating blood volume
in parturients, we examined two groups of patients: group I included patients with pulse
pressure (PP) = 42.3±1.1 mmHg, group II included patients with PP = 30.3±1.4 mmHg.
Conducted research in these groups revealed that:
– PP indicators should be used to determine hypovolemic status and an early
marker of the severity of blood loss, which in terms of diagnostic value exceeds such
hemodynamic indicators as stroke volume (SV), minute blood volume (MBV), cardiac
index (CI), mean arterial pressure (APm);
– statistically significant changes in PP were observed when blood loss was or
exceeded 9.2±1.4% of circulating blood volume (CBV);
– in the absence of statistically significant differences in such indicators of
systemic hemodynamics as SV, MBV, CI and APm, parturient women with PPH and
PP <40 mm Hg had a higher percentage of massive blood transfusions;
– pulse pressure <40 mmHg, which was recorded in parturient women with PPH,
was associated with a longer stay in the intensive care unit (ICU).
When studying lactate indicators as a prognostic marker of complications in
parturients with PPH.
