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Z Geburtshilfe Neonatol
DOI: 10.1055/a-2322-1861
Original Article

Use of Shock Index, Modified Shock Index, and Age-Adjusted Shock Index for Detection of Postpartum Hemorrhage

Cagla Celikkan
1   Obstetrics and Gynecology, Ankara Etlik Zübeyde Hanım Kadın Hastalıkları Eğitim ve Araştırma Hastanesi, Ankara, Turkey
,
Mujde Can Ibanoglu 
2   Obstetrics and Gynecology, Etlik İhtisas Eğitim ve Araştırma Hastanesi, Ankara, Turkey
3   Obstetrics and Gynecology, Ankara Şehir Hastanesi Üniversiteler Mahallesi, Ankara, Turkey
,
Yaprak Engin-Ustun
1   Obstetrics and Gynecology, Ankara Etlik Zübeyde Hanım Kadın Hastalıkları Eğitim ve Araştırma Hastanesi, Ankara, Turkey
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Abstract

Purpose The aim of this study is to evaluate the role of shock index (SI), modified shock index (MSI), and delta shock index (ΔSI) in predicting postpartum hemorrhage (PPH) and adverse maternal outcomes.

Material and Methods In this cross-sectional cohort study, a study group consisting of 416 pregnant women who delivered at our hospital and had postpartum hemorrhage was compared with 467 control patients with normal follow-up. SI (pulse/systolic blood pressure), MSI (pulse/mean arterial pressure), ΔSI (input SI – 2nd- or 6th-hour SI) values were calculated.

Results A total of 883 postpartum women were included in the study. The study group had higher peripartum, 2nd-hour, and 6th-hour SI values (p=0.011, p=0.001, p<0.001, respectively). Peripartum MSI values (p=0.004), 2nd-hour MSI values (p<0.001), and 6th-hour MSI values (p<0.001) were significantly lower in the control group than in the PPH group. When the groups were evaluated, the cut-off value of the 2nd-hour SI parameter was>0.8909 (sensitivity 30%, specificity 84%), and the 6th-hour SI parameter was>0.8909 (sensitivity 40%, specificity 80%) for predicting postpartum hemorrhage requiring blood transfusion and surgical intervention. The cut-off value of the 2nd-hour MSI parameter was>1.2 (sensitivity 34%, specificity 82%), and the cut-off value of the 6th-hour MSI parameter was>1.2652 (sensitivity 32%, specificity 90%).

Conclusion The 2nd- and 6th-hour SI and 2nd- and 6th-hour MSI values were significantly higher in patients with postpartum hemorrhage. Values greater than 0.89 for SI and 1.2 for MSI were considered significant for predicting postpartum hemorrhage with maternal impairment.

Keywords

Diastolic blood pressure - maternal morbidity - mortality - obstetric hemorrhage


Publication History

Received: 08 January 2024

Accepted: 29 April 2024

Article published online:
05 June 2024

© 2024. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Borovac-Pinheiro A, Priyadarshani P, Burke TF. A review of postpartum hemorrhage in low-income countries and implications for strengthening health systems. Int J Gynaecol Obstet 2021; 154: 393-399
    CrossrefPubMedGoogle Scholar
  • 2 Ushida T, Kotani T, Imai K. et al. Shock index and postpartum hemorrhage in vaginal deliveries: A multicenter retrospective study. Shock 2021; 55: 332-337
    CrossrefPubMedGoogle Scholar
  • 3 Patek K, Friedman P. Postpartum Hemorrhage-epidemiology, risk factors, and causes. Clin Obstet Gynecol 2023; 66: 344-356
    CrossrefPubMedGoogle Scholar
  • 4 D'Arpe S, Franceschetti S, Corosu R. et al. Emergency peripartum hysterectomy in a tertiary teaching hospital: a 14-year review. Arch Gynecol Obstet 2015; 291: 841-847
    CrossrefPubMedGoogle Scholar
  • 5 Klumpner TT, Kountanis JA, Meyer SR. et al. Use of a novel electronic maternal surveillance system and the maternal early warning criteria to detect severe postpartum hemorrhage. Anesth Analg 2020; 131: 857-865
    CrossrefPubMedGoogle Scholar
  • 6 Bláha J, Bartošová T. Epidemiology and definition of PPH worldwide. Best Pract Res Clin Anaesthesiol 2022; 36: 325-339
    CrossrefPubMedGoogle Scholar
  • 7 Lord MG, Calderon JA, Ahmadzia HK. et al. Emerging technology for early detection and management of postpartum hemorrhage to prevent morbidity. Am J Obstet Gynecol MFM 2023; 5: 100742
    CrossrefPubMedGoogle Scholar
  • 8 Committee on Practice Bulletins-Obstetrics. Practice Bulletin No. 183: Postpartum Hemorrhage. Obstet Gynecol 2017; 130: e168-e186
    CrossrefPubMedGoogle Scholar
  • 9 Convertino VA, Thompson P, Koons NJ. et al. Superiority of compensatory reserve measurement compared with the shock index for early and accurate detection of reduced central blood volume status. J Trauma Acute Care Surg 2023; 95: S113-S119
    CrossrefPubMedGoogle Scholar
  • 10 Borovac-Pinheiro A, Pacagnella RC. et al. Postpartum hemorrhage: new insights for definition and diagnosis. Am J Obstet Gynecol 2018; 219: 162-168
    CrossrefPubMedGoogle Scholar
  • 11 Burki T. Understanding postpartum haemorrhage. Lancet 2023; 402: 601
    CrossrefPubMedGoogle Scholar
  • 12 Koch E, Lovett S, Nghiem T. et al. Shock index in the emergency department: utility and limitations. Open Access Emerg Med 2019; 11: 179-199
    CrossrefPubMedGoogle Scholar
  • 13 Maneschi F, Perrone S, Di Lucia A. et al. Shock parameters and shock index during severe post-partum haemorrhage and implications for management: a clinical study. J Obstet Gynaecol 2020; 40: 40-45
    CrossrefPubMedGoogle Scholar
  • 14 de Haas S, Mulder E, Schartmann N. et al. Blood pressure adjustments throughout healthy and hypertensive pregnancy: A systematic review and meta-analysis. Pregnancy Hypertens 2022; 27: 51-58
    CrossrefPubMedGoogle Scholar
  • 15 Borovac-Pinheiro A, Cecatti JG. et al. 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. J Glob Health 2019; 9: 020432
    CrossrefPubMedGoogle Scholar
  • 16 Nathan HL, Cottam K, Hezelgrave NL. et al. Determination of normal ranges of shock index and other haemodynamic variables in the immediate postpartum period: A cohort study. PLoS One 2016; 11: e0168535
    CrossrefPubMedGoogle Scholar
  • 17 Cannon CM, Braxton CC, Kling-Smith M. et al. Utility of the shock index in predicting mortality in traumatically injured patients. J Trauma 2009; 67: 1426-1430
    PubMedGoogle Scholar
  • 18 King RW, Plewa MC, Buderer NM. et al. Shock index as a marker for significant injury in trauma patients. Acad Emerg Med 1996; 3: 1041-1045
    CrossrefPubMedGoogle Scholar
  • 19 Rady MY, Nightingale P, Little RA. et al. Shock index: a re-evaluation in acute circulatory failure. Resuscitation 1992; 23: 227-234
    CrossrefPubMedGoogle Scholar
  • 20 Le Bas A, Chandraharan E, Addei A. et al. Use of the "obstetric shock index" as an adjunct in identifying significant blood loss in patients with massive postpartum hemorrhage. Int J Gynaecol Obstet 2014; 124: 253-255
    CrossrefPubMedGoogle Scholar
  • 21 Persichini R, Lai C, Teboul JL. et al. Venous return and mean systemic filling pressure: physiology and clinical applications. Crit Care 2022; 26: 150
    CrossrefPubMedGoogle Scholar
  • 22 Ozakin E, Yazlamaz NO, Kaya FB. et al. Perfusion index measurement in predicting hypovolemic shock in trauma patients. J Emerg Med 2020; 59: 238-245
    CrossrefPubMedGoogle Scholar
  • 23 Kohn JR, Dildy GA, Eppes CS. Shock index and delta-shock index are superior to existing maternal early warning criteria to identify postpartum hemorrhage and need for intervention. J Matern Fetal Neonatal Med 2019; 32: 1238-1244
    CrossrefPubMedGoogle Scholar
  • 24 El Ayadi AM, Nathan HL, Seed PT. et al. Vital sign prediction of adverse maternal outcomes in women with hypovolemic shock: The role of shock index. PLoS One 2016; 11: e0148729
    CrossrefPubMedGoogle Scholar
  • 25 Oglak SC, Obut M, Tahaoglu AE. et al. 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: 863-868
    CrossrefPubMedGoogle Scholar
  • 26 TRAAP Study Group. Madar H, Deneux-Tharaux C, Sentilhes L. Shock index as a predictor of postpartum haemorrhage after vaginal delivery: Secondary analysis of a multicentre randomised controlled trial. BJOG 2024; 131: 343-352 DOI: 10.1111/1471-0528.17634.
    CrossrefPubMedGoogle Scholar
  • 27 Chaudhary M, Maitra N, Sheth T. et al. Shock index in the prediction of adverse maternal outcome. J Obstet Gynaecol India 2020; 70: 355-359
    CrossrefPubMedGoogle Scholar
  • 28 Singh A, Ali S, Agarwal A. et al. Correlation of shock index and modified shock index with the outcome of adult trauma patients: a prospective study of 9860 patients. N Am J Med Sci 2014; 6: 450-452
    CrossrefPubMedGoogle Scholar
  • 29 Magnin M, Amson H, Vacheron CH. et al. Associations between peripheral perfusion disorders, mean arterial pressure and dose of norepinephrine administrated in the early phase of septic shock. Clin Exp Pharmacol Physiol 2021; 48: 1327-1335
    CrossrefPubMedGoogle Scholar
  • 30 Tanacan A, Fadiloglu E, Unal C. et al. Importance of shock index in the evaluation of postpartum hemorrhage cases that necessitate blood transfusion. Women Health 2020; 60: 1070-1078
    CrossrefPubMedGoogle Scholar
  • 31 Lin PC, Liu CY, Tzeng IS. et al. Shock index, modified shock index, age shock index score, and reverse shock index multiplied by Glasgow Coma Scale predicting clinical outcomes in traumatic brain injury: Evidence from a 10-year analysis in a single center. Front Med (Lausanne) 2022; 9: 999481
    CrossrefPubMedGoogle Scholar
  • 32 Spronk E, Sykes G, Falcione S. et al. Hemorrhagic transformation in ischemic stroke and the role of inflammation. Front Neurol 2021; 12: 661955
    CrossrefPubMedGoogle Scholar
  • 33 Bhandarkar P, Munivenkatappa A, Roy N. et al. Pattern and Distribution of Shock Index and Age Shock Index Score Among Trauma Patients in Towards Improved Trauma Care Outcomes (TITCO) Dataset. Bull Emerg Trauma 2018; 6: 313-317
    CrossrefPubMedGoogle Scholar