INTRODUCTION: Obstetric hemorrhage is one of the leading causes of death in obstetric patients in developing countries. Every year, 14 million cases of obstetric hemorrhage occur globally, 1% of them dies. Multiple organ dysfunction syndrome (MODS) occurs between 7% to 15% of patients and has a 90% mortality when three or more organs are affected. METHODS: The aim of this study was to determine the risk to develop MODS in patients with obstetric hemorrhage using laboratory results at critical care unit admission. A retrospective case-control study was conducted in four university hospitals in Bogota, Colombia, between 2008 and 2014. Logistic regression analysis was conducted. RESULTS: We collected information from 277 cases and 558 controls. Of them, 84.9% was pregnant and 15.1% in the puerperium. The mean age was 27.8 years old (SD 7.3) and mean gestational age was 32.1 weeks (SD 7.1). Hemorrhage was the second most frequent diagnosis (12.2%). Multivariate analysis of hemorrhage diagnosis identified factors associated with MODS: creatinine levels equal or greater than 0.65 mg/dL (OR 1.8 95%CI 1.4-5.3; p < 0.003), platelets equal or less than 200.000 mm3 (OR 2.1 95%CI 1.4-3.2; p < 0.000), aspartate aminotransferases equal or greater than 80 (OR3.3 95%CI 1.7-6.6; p < 0.001), alanine aminotransferase equal or greater than 40 (OR 1.9 95%CI 1.1-3.3; p < 0.019) and total bilirubin equal or greater than 0.8 (OR 1.8 95%CI 1.1-3.0; p < 0.016). CONCLUSION: In patients with obstetric hemorrhage, platelet count, serum creatinine, and liver function test can be associated with MODS, even at values considered as normal.
INTRODUCTION: Every day, 800 women die for pregnancy causes around the world, 99% of those in developing countries. The multiple organ dysfunction syndrome (MODS) occurs in 15% of patients in critical care, with a related mortality up to 80%. Some values of arterial blood gas (ABG) analysis has been proposed in few publications in obstetric patients and its relationship with bad outcomes. METHODS: The aim of this study was to describe blood gas thresholds as a risk to develop MODS in obstetric patients. A retrospective case-control study was conducted in four hospitals of Bogota, Colombia, between 2008 and 2014. Logistic regression analysis was conducted. RESULTS: We collected information form 277 cases and 558 controls, of them, 84.9% was pregnant and 15.1% in the puerperium. The mean age was 27.8 years old (SD 7.3), the main diagnosis were hypertensive disorders (52.4%), bleeding (12.2%) and sepsis (12.2%). 490 patients had at least one ABG test, pH, PO2, PCO2, lactate and base deficit were measured. A multivariate analysis was performed, with strata by every main diagnosis as mentioned before. Association with MODS was found in lactate higher than 1.2 mmol/L (OR 2.2 95%CI 1.5-3.4, p < 0.000) and pH less than 7.35 (OR 5.2 95%CI 2.6-10.6, p < 0.000) for patients with preeclampsia; for hemorrhage a base deficit 9 (OR 2.0 95%CI 1.2-3.3, p < 0.006) was founded. There was no association with sepsis founded. CONCLUSION: Patients with MODS and preeclampsia the better ABG predictors were lactate and pH values, and for patients with hemorrhage, base deficit was identified. Prospective studies are needed.
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