Shock Index As A Predictor of Adverse Maternal Outcome In Postpartum Hemorrhage

Sofia Butt, Summaiya Sattar, Tayyeba Anbreen

Abstract

OBJECTIVE:

To determine the accuracy of shock index in predicting adverse maternal outcome in women with postpartum hemorrhage (PPH).

Study design:

Retrospective observational study.

Place and duration of study:

Department of Obstetrics & Gynecology Unit-II, Dr. Ruth K.M Pfau, Civil Hospital Karachi, from October 2018 to March 2021.

METHODOLOGY:

All women who were referred with the diagnosis of PPH were included. Blood loss > 500 ml after vaginal delivery, and > 1000ml after cesarean section was labeled as PPH. Shock index was calculated by dividing heart rate with systolic blood pressure. Adverse maternal outcome were classified according to the WHO criteria and included blood transfusion, intensive care admission, obstetric hysterectomy and maternal death.

Results:

A total of 197 women of primary PPH with a mean age 28.71± 5.33 year and mean body mass index 28.14±3.27 kg/m2 were managed. Majority of the women were delivered by vaginal route (n=184 - 93%) with parity <3 (n=105 – 93%). For blood transfusion, ICU admission, obstetric hysterectomy and maternal death optimal cutoff values of SI were considered as 1.15, 1.28, 1.37 and 1.42, respectively. A SI of 1.42 had 90% specificity and 80% sensitivity for predicting maternal death.

Conclusion:

A raised SI of > 1 predicts adverse maternal outcome among patients presenting with PPH.

Key words:

Postpartum hemorrhage, Shock index, Obstetric hysterectomy, Adverse maternal outcome.