| High incidence of myocardial ischemia during postpartum hemorrhage. | |
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MedLine Citation:
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PMID: 14695721 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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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. |
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Authors:
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Peter C J Karpati; Mathias Rossignol; Marcus Pirot; Bernard Cholley; Eric Vicaut; Patrick Henry; Jean-Philippe Kévorkian; Patrick Schurando; Jacqueline Peynet; Denis Jacob; Didier Payen; Alexandre Mebazaa |
Publication Detail:
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Type: Journal Article; Research Support, Non-U.S. Gov't |
Journal Detail:
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Title: Anesthesiology Volume: 100 ISSN: 0003-3022 ISO Abbreviation: Anesthesiology Publication Date: 2004 Jan |
Date Detail:
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Created Date: 2003-12-26 Completed Date: 2004-02-02 Revised Date: 2007-11-15 |
Medline Journal Info:
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Nlm Unique ID: 1300217 Medline TA: Anesthesiology Country: United States |
Other Details:
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Languages: eng Pagination: 30-6; discussion 5A Citation Subset: AIM; IM |
Affiliation:
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Department of Anesthesiology and Critical Care Medicine, Hôpital Lariboisière, Paris, France. |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Adult Cohort Studies Electrocardiography Female Hemodynamics / physiology Humans Myocardial Contraction / physiology Myocardial Ischemia / complications*, epidemiology*, physiopathology Postpartum Hemorrhage / complications*, epidemiology*, physiopathology Pregnancy Risk Factors Shock, Hemorrhagic / physiopathology Troponin I / blood |
| Chemical | |
Reg. No./Substance:
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0/Troponin I |
| Comments/Corrections | |
Comment In:
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Anesthesiology. 2004 Oct;101(4):1037; author reply 1037-8
[PMID:
15448546
]
Anesthesiology. 2004 Oct;101(4):1036-7; author reply 1037-8 [PMID: 15448545 ] |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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