Abstract
Objective: To assess the diagnostic capacity of bedside capillary lactate (CLact), capillary Haemoglobin (CHb), and shock index (SI) for severe postpartum haemorrhage (SPPH > 2000 ml) at diagnosis, 15 minutes and 30 minutes later. Method: A cohort study was carried out in a reference hospital in San Luis Potosi, Mexico from February 2020 to March 2021, and included sixty women in vaginal labor or c-section who presented PPH (≥500 ml in labor or ≥1000 ml in c-section) measured by the gravimetric method. CLact, SI, and CHb concentrations were analyzed at diagnosis of PPH, 15 minutes, and 30 minutes. Patients who presented total blood loss of >2000 ml were considered SPPH. A T-test or Wilcox test was performed to compare the groups of non-severe and severe. Sensitivity, specificity, and performance were calculated by A Receiver Operating Curve. Results: A CLact measurement at 30 minutes was significantly different between the non-severe and severe groups (4.0 + 1.9 vs 4.8 + 1.15 P-value 0.001, with an optimal cut point of 4.3 mmol/dl at AUC 0.75, sensitivity 0.85, and specificity of 0.62. With a cut-point of 1.17, an AUC of 0.76, sensitivity of 0.43, and specificity of 0.98, SI at diagnosis was significantly different between the non-severe and severe groups (0.70 + 0.20 vs. 0.90 + 0.38 P-value 0.0228). Conclusion: SI is an early sign of SPPH; CLact can significantly identify SPPH after 30 minutes.
Highlights
It is well established that shock index (SI) correlates with SPPH and is a good predictor for transfusion and complications in patients with hypovolemic shock. [5] [6] [7] [8] [9] but it is known that the vital signs are dynamic states, which means they can rapidly change over a short time, and the physiological changes during pregnancy may make vital signs not reliable for the early identification of severe haemorrhage as they are lately modified [10], the calculation of SI involves the use of vital signs, for this reason, we investigate whether the SI is consistently useful over time as an indicator for SPPH
At the diagnosis of postpartum haemorrhage (≥500 ml in labor or ≥1000 ml in c-section, Institutional definition of postpartum haemorrhage), Capillary lactate and Haemoglobin were determined by bedside equipment Acuttrend plus©, and Shock index was calculated as the heart rate (HR) divided by systolic blood pressure (SBP)
Results of this study have shown the capacity of shock index, capillary lactate in identifying severe postpartum haemorrhage defined as blood loss of more than 2000 ml
Summary
During the medical management of these cases, it is of great importance the early recognition of patients with severe cases o may develop severe haemorrhage [3] [4]. For this reason, Obstetricians need to have reliable bedside clinical and biochemical tools to identify patients at risk of a critical condition if they are not provided immediate resuscitation. It is well established that SI correlates with SPPH and is a good predictor for transfusion and complications in patients with hypovolemic shock. [5] [6] [7] [8] [9] but it is known that the vital signs are dynamic states, which means they can rapidly change over a short time, and the physiological changes during pregnancy may make vital signs not reliable for the early identification of severe haemorrhage as they are lately modified [10], the calculation of SI involves the use of vital signs (heart rate divided by systolic blood pressure), for this reason, we investigate whether the SI is consistently useful over time as an indicator for SPPH
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