• Yigal Helviz, Mor Lasry, Sorina Grisaru-Granovsky, Tali Bdolah-Abram, Carolyn F Weiniger, Philip D Levin, and Sharon Einav.
• Intensive Care Unit, Shaare Zedek Medical Center, Jerusalem, Israel. Electronic address: yigalhe@szmc.org.il.
• J Crit Care. 2021 Jun 1; 63: 8-14.

PurposeTo describe shock severity, physiological stabilization and organ failure in healthy women admitted to the intensive care unit (ICU) after major peripartum hemorrhage (PPH).Materials And MethodsRetrospective, descriptive, single center study.ResultsTwenty-nine women median age 33 years (interquartile range [IQR] 30-36) and gravidity 5 pregnancies (IQR 3-9) were studied. One woman died. The median maternal admission hematocrit was 28.8 (IQR 25.7-32.4). Median transfusion rates were nine units of packed red blood cells (IQR 7-12.25), eight fresh frozen plasma (IQR 6-12), 17 platelets (IQR 10-22) and 15 cryoprecipitate (IQR 9.75-20). Blood pressure dropped significantly in the six hours following ICU admission. Nonetheless, lactate decreased from 3.23 mmol/L to 1.54 mmol/L within 24 h of ICU admission, renal and pulmonary function were unaffected and coagulopathy was never observed. Two-thirds of the women underwent hysterectomy. One-third underwent repeated surgery. The median length of ICU stay was <48 h and that of mechanical ventilation was <24 h. Increased transfusion rates correlated with lengthier ICU admission (p ≤ 0.01 regardless of blood product).ConclusionsOngoing hemorrhage in women with severe PPH manifests subtly and often requires active intervention. Hemorrhage control is required to achieve physiological stabilization and minimize organ damage.Copyright © 2021 Elsevier Inc. All rights reserved.

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