Objective: We aimed to assess the association between intrapartum neuraxial labour analgesia (NLA) and shock index values during the peripartum period. Design: A multicentre prospective cohort study. Setting: Two reference centres in Colombia. Population: Obstetric patients in labour with term gestations were divided according to whether they underwent NLA between 2017 and July 2018. Methods: We collected maternal blood pressure and heart rate within the first and second stages of labour and every 30 minutes up to two hours postpartum. We assessed the association between intrapartum NLA and shock index values in a multivariable longitudinal mixed-effect model, adjusting for covariates. Main outcome measures: Shock index changes over time during labour and postpartum periods. Results: We included 522 patients, 228 (43.7%) with NLA and 294 (56.3%) without NLA. Except in the first stage of labour [0.68 (IQR, 0.63-0.74) vs 0.73 (IQR, 0.64-0.82); p=0.07], the shock index values were significantly higher in patients with NLA during the second stage of labour and postpartum (all p values <0.001). In the longitudinal mixed-effect model analysis, shock index values were higher in the NLA group. After adjusting the multilevel model by age, nulliparity, and cervical dilation, the mean shock index without NLA across the measurements was 0.69, while in NLA was 0.76 (mean difference of 0.067). Conclusions: In patients receiving NLA, the shock index values during labour differ from those during the postpartum period. Thus, under these conditions, the shock index should be interpreted differently. Keywords: Shock Index; Neuraxial Labour Analgesia; Postpartum Haemorrhage.
Objectives We aimed to establish new cut-off values for SIRS (Systemic Inflammatory Response Syndrome) variables in the obstetric population. Methods A prospective cohort study in pregnant and postpartum women admitted with systemic infections between December 2017 and January 2019. Patients were divided into three cohorts: Group A, patients with infection but without severe maternal outcomes (SMO); Group B, patients with infection and SMO or admission to the intensive care unit (ICU); and Group C, a control group. Outcome measures were ICU admission and SMO. The relationship between SIRS criteria and SMO was expressed as the area under the receiver operating characteristics curve (AUROC), selecting the best cut-off for each SIRS criterion. Results A total of 541 obstetric patients were enrolled, including 341 with infections and 200 enrolled as the reference group (Group C). The patients with infections included 313 (91.7%) in Group A and 28 (8.2%) in Group B. There were significant differences for all SIRS variables in Group B, compared with Groups A and C, but there were no significant differences between Groups A and C. The best cut-off values were the following: temperature 38.2 °C, OR 4.1 (1.8–9.0); heart rate 120 bpm, OR 2.9 (1.2–7.4); respiratory rate 22 bpm, OR 4.1 (1.6–10.1); and leucocyte count 16,100 per mcl, OR 3.5 (1.6–7.6). Conclusions The cut-off values for SIRS variables did not differ between healthy and infected obstetric patients. However, a higher cut-off may help predict the population with a higher risk of severe maternal outcomes.
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