High incidence of myocardial ischemia during postpartum hemorrhage.
BACKGROUND
Postpartum hemorrhage remains a major cause of global maternal morbidity and mortality, even in developed countries, despite the use of intensive care units. This study sought to (1) assess whether myocardial ischemia could be associated with and even aggravate hemorrhagic shock in young parturients admitted for postpartum hemorrhage, and (2) identify the independent risk factors for myocardial ischemia.


METHODS
On their referral to the intensive care unit, a multidisciplinary team managed parturients with severe postpartum hemorrhage. Ventilation, transfusion, catecholamines, surgery, or angiography with uterine embolization were provided as clinically indicated. Plasma cardiac troponin I levels were used as a surrogate marker of acute myocardial injury and electrocardiograms of myocardial ischemia.


RESULTS
A total of 55 parturients were referred with severe postpartum hemorrhage, all in hemorrhagic shock. Twenty-eight parturients (51%) had elevated serum levels of cardiac troponin I (9.4 microg/l [3.7-26.6 microg/l]), which were associated with electrocardiographic signs of ischemia and deteriorated myocardial contractility and correlated with the severity of hemorrhagic shock. Indeed, multivariate analysis identified low systolic and diastolic arterial blood pressure (< 88 and < 50 mmHg, respectively) and increased heart rate (> 115 beats/min) as independent predictors of myocardial injury. In addition, all patients who were given catecholamines also had elevated cardiac troponin I levels.


CONCLUSIONS
These results suggest that treatment of postpartum hemorrhage-induced hemorrhagic shock should be coupled with concomitant prevention of myocardial ischemia, even in young parturients.
Karpati
Peter C J
PC
Department of Anesthesiology and Critical Care Medicine, Hôpital Lariboisière, Paris, France.
Rossignol
Mathias
M
Pirot
Marcus
M
Cholley
Bernard
B
Vicaut
Eric
E
Henry
Patrick
P
Kévorkian
Jean-Philippe
JP
Schurando
Patrick
P
Peynet
Jacqueline
J
Jacob
Denis
D
Payen
Didier
D
Mebazaa
Alexandre
A
D000328:Adult; D015331:Cohort Studies; D004562:Electrocardiography; D005260:Female; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D009200:Myocardial Contraction / Q000502:physiology; D017202:Myocardial Ischemia / Q000150:complications* / Q000453:epidemiology* / Q000503:physiopathology; D006473:Postpartum Hemorrhage / Q000150:complications* / Q000453:epidemiology* / Q000503:physiopathology; D011247:Pregnancy; D012307:Risk Factors; D012771:Shock, Hemorrhagic / Q000503:physiopathology; D019210:Troponin I / Q000097:blood
D019210:Troponin I