Case–control study of shock index among women who did and did not receive blood transfusions due to postpartum hemorrhage

Borovac-Pinheiro, Anderson; Pacagnella, Rodolfo C.; Puzzi-Fernandes, Carolina; Cecatti, José Guilherme

doi:10.1002/ijgo.12343

Cited by 9 publications

(14 citation statements)

References 24 publications

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“…In the previous studies, the SI values above 0.9 in the postpartum period were related to blood loss above 1500 mL, UCI admission [18,19], and massive transfusion [17,18]. Statistically significant higher SI values were found in women that received blood transfusion due to PPH after vaginal delivery [15].…”

Section: Discussionmentioning

confidence: 97%

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Shock index and heart rate standard reference values in the immediate postpartum period: A cohort study

2019

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Objective To determine Shock Index (SI) reference values in the first two hours of the postpartum period after objectively measuring postpartum bleeding. Materials and methods A complementary analysis using data from a prospective cohort study at Women’s Hospital of the University of Campinas, Brazil, between 1 February 2015 and 31 March 2016. It included women giving birth vaginally unless they had one of these conditions: gestational age below 34 weeks, hypertension, hypo- or hyperthyroidism without treatment, any cardiac disease, infections with fever or sepsis, history of coagulopathy or delivery by C-section. Blood loss was measured by adding the blood volume collected in the drape placed under the women’s buttocks and the weight of gauzes and compresses used (excluding the dry weight). Vital signs were measured every 5–15 min after delivery. Exploratory data analysis was performed to assess the mean, standard deviation, median, and percentiles (5 th , 10 th , 25 th , 50 th , 75 th , 90 th , 95 th ). To identify variation among the periods after delivery, the mean SI and heart rate (HR) values observed for the following intervals were used in the analysis: 0–20 min, 21–40 min, 41–60 min, 61–90 min and 91–120 min. Results One hundred eighty-six women were included. The mean age ± SD was 24.9 ± 6.1 years and the mean gestational age at birth was 39.2 ± 1.8 weeks. At the puerperal period, the mean SI values ranged from 0.68 ± 0.14 to 0.74 ± 0.15. The percentile distribution ranged from 0.46 (5 th percentile) to 1.05 (95 th percentile). The mean HR values ranged from 80.8 ± 12.7 bpm to 92.3 ± 14.4 bpm. The percentile distribution ranged from 62.0 bpm (5 th percentile) to 117 bpm (95 th percentile). Conclusion Reference ranges were established for SI and HR values which showed small variations throughout the postpartum period.

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Section: Discussionmentioning

confidence: 97%

“…Some studies have shown the relationship between increased SI values and severe postpartum outcomes related to PPH [15–20]. In the previous studies, the SI values above 0.9 in the postpartum period were related to blood loss above 1500 mL, UCI admission [18,19], and massive transfusion [17,18].…”

Section: Discussionmentioning

confidence: 99%

Shock index and heart rate standard reference values in the immediate postpartum period: A cohort study

2019

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“…Other studies have shown that SI values above 0.9 are associated with severe maternal outcomes due to PPH, including maternal death, ICU admission, blood transfusion of ≥4 blood units and invasive surgical interventions. (21,24) A previous study from our group showed that 30 minutes after delivery, the mean SI value found among women who received blood transfusion after vaginal delivery due to PPH was 0.88 ± 0.26 [22].…”

Section: Discussionmentioning

confidence: 98%

Ability of shock index and heart rate to predict the percentage of body blood volume lost after vaginal delivery as an indicator of severity: results from a prospective cohort study

Borovac-Pinheiro

Cecatti

Pacagnella

2019

Journal of Global Health

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BackgroundPostpartum hemorrhage (PPH) is the leading cause of maternal mortality worldwide, but it mainly affects women from low- and middle-income countries. Despite being a treatable condition, the high number of maternal deaths resulting from PPH is outstanding for at least 25 years. Late diagnosis and difficulties in identifying women who will develop severe postpartum bleeding can, in part, explain the high incidence of PPH. Over the past few years, researchers have focused on identifying a simple, accessible and low-cost diagnostic tool that could be applied to avoid maternal deaths. In particular, it has been suggested that vital signs and shock index (SI) could be useful. The objective of this study was to evaluate whether vital signs are correlated with the percentage of body blood volume (BBVp) lost after vaginal delivery.MethodsA prospective cohort study was performed at the Women’s Hospital of UNICAMP, Brazil. The inclusion criteria were women delivering vaginally who did not suffer from hypertension, hyper- or hypothyroidism, cardiac disease, infections or coagulopathy. Blood loss was measured over 24 hours using a calibrated drape and by weighing compresses, gauzes and pads. Vital signs were measured up to 24 hours after delivery. We evaluated the BBVp lost, and generated a Receiver operating characteristics (ROC) curve with area under the curve (AUC) analysis to determine the cut-off values for vital signs to determine the likelihood of postpartum bleeding above the 90th percentile within 24 hours of delivery.ResultsA total of 270 women were included. The mean blood loss within 24 hours of vaginal delivery was 570.66 ± 360.04 mL. In the first 40 minutes, 73% of the total blood loss over the 24-hour period had occurred, and within 2 hours, 91% of women had bled 90% of the total blood loss. Changes in SI and heart rate (HR) were statistically significant in predicting postpartum bleeding (P ≤ 0.05). Higher values for likelihood ratio (LR) to identify BBVp loss above the 90th percentile within 2 hours were a SI above 1.04 at 41-60 minutes after birth (LR = +11.84) and a HR above 105.2 bpm at 21-40 minutes after birth (LR = +4.96). Both measures showed high specificity but low sensitivity.ConclusionValues of SI and HR are statistically significant in predicting postpartum bleeding with high specificity but low sensitivity. The cut-off points were 1.04 for SI and 105 bpm for HR.

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“…Clinicians emphasize a need for early warning criteria for PPH, which has a higher sensitivity to physiologic changes, ease of application in clinical practice, and prioritization of both the lost blood volume and its clinical outcomes, to indicate the severity of blood loss. 12 Shock index (SI), the ratio of HR divided by SBP, has been proposed as an early and reliable predictor of adverse outcomes in non-obstetric trauma and obstetric hemorrhage patients compared with conventional vital signs. 6 Clinical and experimental studies have shown that SI has an inverse linear correlation with left ventricular stroke work in acute circulatory failure.…”

Section: Introductionmentioning

confidence: 99%

A prospective cohort study of shock index as a reliable marker to predict the patient’s need for blood transfusion due to postpartum hemorrhage

et al. 2021

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Objective: This study was aimed to compare the shock index (SI) values between patients who required blood transfusion due to postpartum hemorrhage (PPH) and patients who received no blood transfusion. Methods: We conducted this cross-sectional study at a tertiary center between January 2019 and June 2019. A total of 2534 patients who underwent vaginal delivery were included in this study. We measured SI values upon admission, 30 minutes, 1-hour, and 2-hours after delivery. We identified women who required blood transfusion as the study group. Control patients who delivered in the same period and received no blood transfusion were identified in the medical record system and randomly selected. Age, parity, BMI, and SI values at each one prepartum and three postpartum periods of the groups were analyzed. Results: A total of 2534 patients were included in the study. A varying amount of blood transfusion was performed in 54 patients (2.13%). When we compared with patients who did not receive blood transfusion after delivery, patients who received any amount of blood transfusion after vaginal delivery had significantly higher SI values 30 minutes after delivery (0.99±0.20, and 085±0.11, p=0.0001), at 1-hour (1.00±0.18, and 0.85±0.11, p=0.0001), and 2-hours (1.09±0.16, and 0.87±0.11, p=0.0001). Conclusion: SI value could be a reliable and consistent marker to predict the requirement for any amount of blood transfusion due to PPH. doi: https://doi.org/10.12669/pjms.37.3.3444 How to cite this:Oglak SC, Obut M, Tahaoglu AE, Demirel NU, Kahveci B, Bagli I. A prospective cohort study of shock index as a reliable marker to predict the patient’s need for blood transfusion due to postpartum hemorrhage. Pak J Med Sci. 2021;37(3):---------. doi: https://doi.org/10.12669/pjms.37.3.3444 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Case–control study of shock index among women who did and did not receive blood transfusions due to postpartum hemorrhage

Cited by 9 publications

References 24 publications

Shock index and heart rate standard reference values in the immediate postpartum period: A cohort study

Shock index and heart rate standard reference values in the immediate postpartum period: A cohort study

Ability of shock index and heart rate to predict the percentage of body blood volume lost after vaginal delivery as an indicator of severity: results from a prospective cohort study

A prospective cohort study of shock index as a reliable marker to predict the patient’s need for blood transfusion due to postpartum hemorrhage

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