Renal Dysfunction in Patients with Postpartum Hemorrhage

Abstract

The purpose of the study was to assess the influence of the hematocrit level on the frequency of development of renal dysfunction in massive obstetric bleeding. Materials and methods. For the study, we selected 33 women in labor in whom low hematocrit values were determined as a result of blood loss. The examined group had no risk factors and signs of renal dysfunction in the prenatal period. The average age of the women in labor was 32.5 ± 6.4 years, the average weight was 76.5 ± 12.4, and the average gestational age was 39.5 ± 1.5 weeks. Postpartum blood loss averaged 1830.5 ± 622.7 ml (from 1200 to 2500 ml). All bleeding was stopped according to current protocols. Results and discussion. Despite improvements in prenatal and delivery care, postpartum acute kidney injury, associated with massive postpartum blood loss and blood transfusions, currently remains a serious problem. A lot of factors play a role in kidney damage and the development of postpartum acute kidney injury, but it is largely related to hemodilution and low values of hematocrit and hemoglobin. At the same time, there are currently no reliable data on hematocrit threshold values in patients undergoing infusion therapy against the background of postpartum blood loss. Acute kidney injury was defined according to the Kidney Disease: Improving Global Outcomes 2012 recommendations as the presence of at least one of the following criteria: an increase in serum creatinine concentration ≥0.3 mg/dl (≥26.5 μmol/l) within 48 hours, or an increase in serum creatinine concentration ≥1.5 times from the baseline, which is known or assumed to have occurred within 7 days, or a diuresis rate <0.5 ml/kg/h within 6 hours. Conclusion. As a result of the research, it was established that the following pathological conditions and nosologies were the most frequent causes of postpartum acute kidney injury: HELLP syndrome (75% of cases), preeclampsia (70.8% of cases), postpartum hemorrhage (58.3% of cases) and gestational hypertension (45.8% of cases). At the same time, the most frequent clinical manifestation of acute kidney injury occurred with the development of oliguria/anuria (45.8%), hypertension more than 140/90 mm Hg (37.5%) and eclampsia (29.2%). The functional state of the kidneys (namely, the glomerular filtration rate) depended on the hematocrit level, and when its values decreased, the glomerular filtration rate decreased significantly. The obtained dependence was statistically reliable, which was indicated by the value of p=0.0000132 and corresponded to a strong positive correlation, which was indicated by the value r = 0.9449 and r2 = 0.8928. Hematocrit values in the range of 19.57 ± 2.18% and below are a risk factor for the development of postpartum renal dysfunction