Resuscitation in Obstetric Hemorrhage: “Less Is More”

Abstract

Obstetric hemorrhage accounts for one-third of maternal deaths worldwide. Risk factors have been identified, being common in developing countries. Mortality due to this complication has increased in recent years in countries like United States. Therefore, intensivists should be aware of the clinical tools and technology available for diagnosing and treating patients with severe hemorrhage. The main goal of resuscitation is to restore tissue oxygen delivery and perform initial management with crystalloids, while evaluating perfusion windows, which has been a long-time study, followed by transfusion of blood products (if initially not available) with the aim of restoring circulating volume. In recent years, complications of a large volume of fluids during resuscitation have proved harmful, as fluid accumulation in different organs such as the brain, heart, lung, and kidneys may cause edema, decreased lactate clearance, oxygen diffusion, weaning failure, increased hospital stay, and coagulopathy. The “less is more” approach is a strategy based on optimizing resources such as time to evaluation, treatment with fluids and blood products, clinical and laboratory data to assess severity to provide stabilization, and avoiding common complications in the ICU due to severe hemorrhage.