ICU Management After Major Obstetric Hemorrhage

Abstract

Major obstetric hemorrhage is an extremely challenging obstetric emergency associated with significant morbidity and mortality. Obstetric hemorrhage is the world’s leading cause of maternal mortality. Hemostasis is the process that maintains the integrity of a closed, high-pressure circulatory system after vascular damage, it is a critical event in the arterial diseases associated with Myocardial Infarction (MI) and stroke, and venous thromboembolic disorders account for considerable morbidity and mortality Endothelium is the major synthetic and storage site for von Willebrand Factor (VWF). It is secreted from the endothelial cell both into the plasma and also abluminally into the subendothelial matrix. The platelet, the vessel wall, with its inner lining of endothelium, which contain 3 thromboregulators nitric oxide, prostacyclin and the ectonucleotidase together provide a defense against thrombus formation. Collagen in the subendothelial matrix and tissue factor facilitate the maintenance of a closed circulatory system. When the vessel wall is breached or the endothelium is disrupted, collagen and tissue factor become exposed to the flowing blood, thereby initiating formation of a thrombus. Exposed collagen triggers the accumulation and activation of platelets, whereas exposed tissue factor initiates the generation of thrombin, which not only converts fibrinogen to fibrin but also activates platelets.Platelet plaque formationalong with vasospasm and activate of platelets at the site of vascular injury to form a platelet plug constitutes the primary response to hemostasis.