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Medicina crítica (Colegio Mexicano de Medicina Crítica)
Print version ISSN 2448-8909
Abstract
GUTIERREZ LOPEZ, María de Lourdes; CARMONA DOMINGUEZ, Aurea and MONTELONGO, Felipe de Jesús. Role of the shock index in pregnancy of the third quarter with obstetric hemorrhage for transfusion requirement attended at the «Las Americas» General Hospital. Med. crít. (Col. Mex. Med. Crít.) [online]. 2019, vol.33, n.1, pp.15-20. Epub Dec 04, 2020. ISSN 2448-8909.
Obstetric hemorrhage remains the most important cause of maternal deaths worldwide. A woman in the third trimester may lose up to 30% of the blood volume before the SBP falls, leading to hemodynamic stability and delayed attention. The shock index (SI), calculated as a heart rate divided by systolic blood pressure, has been proposed to predict early hypovolemia. In non-pregnant population, normal SI has been suggested as 0.5-0.7 and SI ≥ 0.9 corresponds with higher mortality and morbidity. So far, only a small obstetric study has defined normal SI, such as 0.7-0.9.
Study design:
The shock index was calculated in pregnant patients in the third trimester who arrived with obstetric hemorrhage in the third trimester, of which they reached grade III hypovolemic shock. The effect of the adjustment of the confounding factors on the relationship between the SI thresholds and the result was evaluated, using logistic regression methods.
Results:
Our study is the first to evaluate the predictive capacity of shock rate in pregnant women with a history of hemorrhage in the third trimester demonstrating that it does not help to make decisions about final treatment and adverse events, since the hemodynamic changes of pregnancy and postpartum may delay the recognition of hypovolemia by underestimating early resuscitation and referral.
Conclusion:
The shock index is not a valuable predictor of maternal deterioration, but it does impact on the need for transfusion or surgical intervention in the context of third trimester hemorrhage. We propose an SI threshold ≥ 0.9 to identify women who require urgent high-level care. This is higher than the upper limit of normality in non-pregnant populations, reflecting the hemodynamic changes of pregnancy and the postpartum period.
Keywords : Hypovolemic shock; postpartum hemorrhage; shock index.
