Early prognostic capacity of serum lactate for severe postpartum hemorrhage

Abstract

Objective To evaluate whether the concentration of serum lactate during the diagnosis of postpartum hemorrhage (bleeding ≥500 mL during labor or ≥1000 mL during cesarean delivery) predicts severe hemorrhage (SPPH; blood loss ≥1500 mL at end of labor or in the following 24 h). Methods A prospective cohort pilot study was conducted of women with a vaginal or cesarean delivery from February 2018 to March 2019 who presented with bleeding ≥500 mL measured by the gravimetric method in a reference hospital in San Luis Potosi, Mexico. Venous blood samples were taken for analysis of serum lactate. A receiver operating characteristic curve determined the serum lactate threshold value for SPPH and χ2 test assessed the difference in serum lactate elevation between SPPH and non‐SPPH groups. Lastly, the prognostic capacity between the thresholds was compared. Results SPPH developed in 43.33% of the 30 women in the study group. The best prognostic threshold was 2.68 mmol/L of serum lactate (odds ratio [OR] 17.88, 95% confidence interval [CI] 2.7–16.8, P < 0.001); sensitivity was 0.85 (95% CI 0.55–0.98); specificity was 0.76 (95% CI 0.50–0.93). Conclusion Serum lactate may be a useful prognostic marker for SPPH, more studies are needed to validate these findings.

Diagnostic performance of serial bedside Capillary Hemoglobin, Lactate and Shock index for severe postpartum hemorrhage. A Prospective Cohort Study.

“…Our research revealed that the bedside serum capillary lactate as a point-of-care test can differentiate the severe group from non-severe for this reason allows quick during lactate-guided recusation and probably reduce risk of thrombophlebitis that may result from venous sampling. Previously it was reported that venous lactate of 2.6 mmol/dl at the diagnosis of postpartum haemorrhage may be a good predictor for severe haemorrhage (sensitivity of 0.85 and specificity was 0.76) (10). For the case of capillary lactate, these outpoint seem to be higher, this may be a multifactorial effect including lactate detection method and compensatory mechanisms of peripheric blood constriction to guarantee blood flow to vital organs.…”

“…(4)(5)(6)(7). Serum lactate and shock index have shown to be a good and early predictor of complications and necessity for transfusion, but in most of the low resourced facilities, it may be difficult to timely get it realized (8)(9)(10). Understanding the need for reliable bedside clinical tools to identify patients at risk of reaching a critical condition if they are not provided immediate resuscitation we investigated the use of bedside and minimally invasive protocol by measuring capillary lactate and haemoglobin with Acuttrend(r) Lactate and HemoCue(r) respectively.…”