To investigate fluid management and risk factors of intra-abdominal hypertension (IAH) after postpartum hemorrhage.

Clinical data of 64 patients of postpartum hemorrhage who were admitted to Intensive Care Unit (ICU) of the First People's Hospital of Kunming from January 2013 to January 2015 were collected. The patients were divided into IAH group and non-IAH group based on intra-abdominal pressure on admission to ICU. Diuresis or dialysis were offered to patients whose output exceeded 1 000 ml of their input after hospitalization. The background information, including maternal age, existence of pre-eclampsia and whether hysterectomy and transcatheter arterial embolization were performed, intra-abdominal pressure, liver and renal function and length of stay in hospital between the two groups were compared. The intra-abdominal pressure and liver and renal function before and 24 h after negative fluid administration of all subjects were compared as well. Independent-samples t test, paired-samples t test,Chi-square test and logistic regression analysis were applied for statistics.

Among all of the 64 patients, 15(23.4%) presented with IAH on admission, 25 (39.1%) were complicated with preeclampsia, one (1.6%) had the uterus removed, and 16 (25.0%) had transcatheter arterial embolization performed. Within 12 h before admission, the average blood loss of the 64 women was (4 022±1 275) ml, crystal solution input was (8 894±2 597) ml, colloidal fluid input was (343±87) ml, blood products input was (1 370±346) ml, total fluid input was (10 607±2 825) ml, total fluid output was (5 176±2 334) ml, average fluid input per hour was (884±235) ml and average urinary production per hour was (431±195) ml. Logistic regression analysis showed that pre-eclampsia (OR=5.30, 95%CI: 1.15-24.45), average fluid input per hour > 1 000 ml (OR=5.34, 95%CI: 1.14-24.92) andaverage urinary production per hour≤200 ml (>200 ml,OR=0.17, 95%CI: 0.05-0.58) were risk factors of IAH. The non-IAH group showed shorter length of stay in ICU [(3.33±1.84) vs (8.73±9.77) d] and shorter length of stay in hospital [(10.29±3.96) vs (18.13±9.88) d] than IAH group (t=-3.71 and-4.55, both P<0.05).After 24 hoursnegative fluid administration, the intra-abdominal pressure [(6.67±4.61) vs (8.47±5.85) mmHg (1 mmHg=0.133 kPa),t=7.76], total serum bilirubin level [(14.31±14.91) vs (20.96±37.56)μmol/L,t=2.02], blood urea nitrogen level [(6.49±5.18) vs (7.57±7.07) mmol/L,t=2.72] and creatinine level [(105.57±81.66) vs (140.61±126.14)μmol/L,t=5.33] were all significantly decreased comparing with before negative fluid administration, but the serum albumin level rised up [(24.45±4.80) vs (21.35±5.69) g/L,t=-4.47].

Pre-eclampsia, massive fluids input and too little output per hour in patients complicated with postpartum hemorrhage were risk factors of IAH. IAH is harmful to liver and kidney, and makes the length of stay in hospital longer. However, negative fluid administration could decrease the intra-abdominal pressure and improve the function of liver and kidney.

Postpartum hemorrhage; Intra-abdominal hypertension; Renal replacement therapy; Diuresis