Assessment of volemic status in postpartum period: a pilot prospective cohort study

Abstract

Introduction. The concept of permissible blood loss during childbirth and during caesarean section (CS) remains a subject of discussion. Also, a controversial issue is the adequacy of the assessment of the volume of blood loss in women in labor based on body weight. Criteria for the appointment of infusion therapy for postpartum hemorrhage (PPH) I-II stage are controversial and require research in this area. Objectives. Determination of the optimal method for assessing blood volume loss to identify women with PPH. Materials and methods. In a pilot prospective cohort study, 30 pregnant, prepared for planned CS. The primary endpoints of the study were the assessment of the volume of blood loss depending on the method of determination, the assessment of TTE and ultrasound of the inferior vena cava in postpartum period after elective CS. Results. Assessment of the volume of blood loss as a percentage of the circulating blood volume revealed 30 % of women with PPH who were not diagnosed by visual assessment, and 16 % of women with PPH who were not diagnosed by gravimetric assessment of the volume of blood loss. Postpartum hemorrhage I-II gr. does not always require replacement fluid therapy. Statistically significant large indices of the collapse index of the inferior vena cava and central hemodynamics indicated a hyperdynamic response of the circulatory system in postpartum women with postpartum hemorrhage due to the redistribution of the water sector. Conclusions. The calculation of the blood volume by the patient’s weight during pregnancy leads to an underestimation of the frequency of PPH of I-II severity in almost every 6 women. The data obtained cast doubt on the existing classification of postpartum hemorrhage depending on the amount of blood loss and require further research in this area to determine the optimal methods for diagnosing the severity of PPH.