High Incidence of Myocardial Ischemia during Postpartum Hemorrhage

Kárpáti, P; Rossignol, Mathias; Pirot, Marcus; Cholley, Bernard; Vicaut, Éric; Henry, Patrick; Kévorkian, Jean-Philippe; Schurando, Patrick; Peynet, Jacqueline; Jacob, Denis; Payen, Didier; Mebazaa, Alexandre

doi:10.1097/00000542-200401000-00009

Cited by 104 publications

(49 citation statements)

References 25 publications

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“…Excessive blood loss is more likely during intrapartum caesareans and oxytocin could be detrimental to women who are hypovolemic. 11,15,[17][18][19] It is reasonable to assume that ST-depressions are as common during intrapartum caesareans and the clinical significance of our results could be more important within such circumstances.…”

Section: Discussionmentioning

confidence: 99%

“…15,16 Oxytocin could be detrimental to women who are hypovolemic and to women with cardiac disease. 11,15,[17][18][19] As oxytocin has dose-dependent adverse effects, we were interested in finding out whether there are any differences in the rate of ECG changes indicating myocardial ischaemia (ECG depression) between two different doses of oxytocin.…”

Section: Introductionmentioning

confidence: 99%

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ST depression at caesarean section and the relation to oxytocin dose. A randomised controlled trial

Jonsson

Hanson

Lidell

et al. 2009

BJOG

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Objective To investigate whether there is a difference in occurrence of electrocardiogram changes suggestive of myocardial ischaemia between two different doses of oxytocin.Design Double-blind randomised controlled trial Setting University hospital in Sweden.Population A total of 103 healthy women undergoing elective caesarean section under spinal anaesthesia.Methods The participants were randomised to 5 or 10 units of oxytocin, given as an intravenous bolus. A Holter monitor was used to record electrocardiograms and non invasive blood pressure and heart rate (HR) was monitored. A blood sample was obtained 12-hour postoperatively.Main outcome measures Depression of the ST segment. Secondary outcomes: symptoms, Troponon I levels, mean arterial pressure (MAP), HR and blood loss.Results There was a significant difference in occurrence of ST depressions associated with oxytocin administration, 4 (7.7%) with 5 and 11 (21.6%) with 10 units, P < 0.05. The absolute risk reduction was 13.9% (95% confidence interval, 0.5-27.3). Decrease of mean MAP from baseline to 2 minutes differed, being 9 mmHg in the 5 unit group and 17 mmHg in the 10 unit group (P < 0.01). The increase in mean HR did not differ. Troponin I levels were increased in four subjects (3.9%). There were no differences in occurrence of symptoms, Troponin I levels, or estimated blood loss.Conclusion ST depressions were associated with oxytocin administration significantly more often in subjects receiving 10 units compared with 5 units. Interventions to prevent hypotension during caesarean section may reduce the occurrence of ST depressions on electrocardiograms.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

ST depression at caesarean section and the relation to oxytocin dose. A randomised controlled trial

Jonsson

Hanson

Lidell

et al. 2009

BJOG

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“…This practice has been challenged by a recent study demonstrating decreased mortality in critically ill patients who were transfused at lower hemoglobin thresholds (ie, transfusions administered with hemoglobin concentrations less than 7 g/dL) [12]. On the other end of the spectrum, Karpati and colleagues [13] found an approximately 50% incidence of myocardial ischemia in intensive care patients admitted with postpartum hemorrhage and hypovolemic shock. Risk factors for myocardial ischemia in this population were a hemoglobin of 6.0 g/dL or lower, systolic blood pressure of 88 mm Hg or lower, diastolic blood pressure of 50 mm Hg or lower, and a heart rate greater than 115 beats per minute [13].…”

Section: Determining When To Transfusementioning

confidence: 99%

“…On the other end of the spectrum, Karpati and colleagues [13] found an approximately 50% incidence of myocardial ischemia in intensive care patients admitted with postpartum hemorrhage and hypovolemic shock. Risk factors for myocardial ischemia in this population were a hemoglobin of 6.0 g/dL or lower, systolic blood pressure of 88 mm Hg or lower, diastolic blood pressure of 50 mm Hg or lower, and a heart rate greater than 115 beats per minute [13].…”

Section: Determining When To Transfusementioning

confidence: 99%

Blood Component Therapy in Obstetrics

Fuller¹,

Bucklin²

2007

Obstetrics and Gynecology Clinics of North America

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“…Los cuatro probables ritmos de paro son: dos desfibrilables (la fibrilación ventricular, la taquicardia ventricular sin pulso) y dos no desfibrilables (asistolia y la actividad eléctrica sin pulso); los ritmos de paro no desfibrilables son más frecuentes en gestantes, aunque existen reportes de alteraciones de las enzimas cardiacas sugestivas de lesión miocárdica en gestantes con hemorragia obstétrica mayor que pudieran desencadenar ritmos de paro desfibrilables (31). La desfibrilación no está contraindicada en el embarazo, aunque sí se debe tener la precaución de retirar los dispositivos de monitorización fetal externa o interna antes de realizarla (3,4,11,14,21).…”

Section: Modificaciones De Los Cinco Eslabones De La Reanimación Cardunclassified

Resucitación cardiopulmonar y cerebral en la embarazada. Al final del colapso materno

Vasco-Ramírez¹

2014

Rev. Colomb. Obstet. Ginecol.

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<p style="font: small/normal verdana; color: #000000; text-transform: none; text-indent: 0px; letter-spacing: normal; word-spacing: 0px; white-space: normal; widows: 1; font-size-adjust: none; font-stretch: normal; -webkit-text-stroke-width: 0px;">Objetivo: proporcionar a los profesionales de la salud involucrados en el manejo de gestantes con complicaciones (obstetras, enfermeras, médicos generales y de emergencias, anestesiólogos, intensivistas, entre otros) los principios fundamentales de prevención y manejo de paro cardiorrespiratorio (PCR) en este grupo poblacional con el fin de mejorar los resultados del binomio madre-hijo.<p style="font: small/normal verdana; color: #000000; text-transform: none; text-indent: 0px; letter-spacing: normal; word-spacing: 0px; white-space: normal; widows: 1; font-size-adjust: none; font-stretch: normal; -webkit-text-stroke-width: 0px;">Materiales y métodos: el documento se basa en una búsqueda de publicaciones en las bases de datos Medline, SciELO y Embase utilizando los términos "Cardiopulmonary Resuscitation, Pregnancy, Perimortem Cesarean, Maternal Cardiac Arrest, Cardiac arrest in pregnancy", y restringida a los siguientes tipos de publicación: "Meta Analysis, Systematic Reviews, Practice Guideline, Randomized Controlled Trial, Review, Case Report, Chapter, Editorial, Survey".<p style="font: small/normal verdana; color: #000000; text-transform: none; text-indent: 0px; letter-spacing: normal; word-spacing: 0px; white-space: normal; widows: 1; font-size-adjust: none; font-stretch: normal; -webkit-text-stroke-width: 0px;">Resultados: se encontraron 78 títulos de los cuales se incluyeron 63; de estos, 22 corresponden a revisiones narrativas, 20 a reportes y series de caso, 8 a guías de práctica clínica, 5 a ensayos clínicos, 4 editoriales, 2 corresponden a revisiones sistemáticas o metaanálisis, 1 capítulo de libro y 1 encuesta o survey.<p style="font: small/normal verdana; color: #000000; text-transform: none; text-indent: 0px; letter-spacing: normal; word-spacing: 0px; white-space: normal; widows: 1; font-size-adjust: none; font-stretch: normal; -webkit-text-stroke-width: 0px;">Conclusiones: el paro cardiaco en gestantes impone un reto al grupo interdisciplinario que lo enfrenta, por ser una entidad de baja frecuencia que se puede asociar a un alto grado de morbimortalidad materna y perinatal. Las principales acciones por realizar son: activación del código azul obstétrico con respuesta adecuada para realización de histerotomía de emergencia oportuna, compresiones torácicas de buena calidad, desviación manual uterina 15º a la izquierda cuando el útero grávido se palpe por encima del ombligo materno, manejo avanzado farmacológico y de vía aérea, y cuidado óptimo luego de la resucitación para la madre y el neonato.

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High Incidence of Myocardial Ischemia during Postpartum Hemorrhage

Abstract: These results suggest that treatment of postpartum hemorrhage-induced hemorrhagic shock should be coupled with concomitant prevention of myocardial ischemia, even in young parturients.

Cited by 104 publications

References 25 publications

ST depression at caesarean section and the relation to oxytocin dose. A randomised controlled trial

ST depression at caesarean section and the relation to oxytocin dose. A randomised controlled trial

Blood Component Therapy in Obstetrics

Resucitación cardiopulmonar y cerebral en la embarazada. Al final del colapso materno

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