medigraphic.com
Federación Mexicana de Ginecología y Obstetricia, A.C.

2018, Number 10

<< Back Next >>

Ginecol Obstet Mex 2018; 86 (10)

Utility of the shock index in obstetric hemorrhage as a predictive value for the transfusion requirement

Guerrero-De León, María Cristina; Escárcega-Ramos, Luis Raúl; González-Días, Óscar Armando; Palomares-Leal, Alain; Gutiérrez-Aguirre, César Homero

Language: Spanish
References: 17
Page: 665-674
PDF size: 313.32 Kb.


ABSTRACT

Objective: To determine the cut-off point of obstetric shock index associated with massive transfusion in women with obstetric hemorrhage.
Materials and Methods: We designed a cross-sectional study in women who were admitted to the intensive care unit. The obstetric shock index was calculated at the time of the diagnosis of obstetric hemorrhage. We analyzed vital signs, arterial blood gas, loss of blood, fluid replacement and transfused blood products.
Results: One hundred and five women with obstetric bleeding were included, in 65 (61%) the obstetric shock index was ≥ 0.9, of whom 38 (58%) needed massive transfusion. Obstetric shock index ≥ 0.9 was significantly associated with massive transfusion (p ‹ 0.001). The blood loss was of 3000 mL (RIC 2000 mL) in the patients with obstetric shock index ≥ 0.9 compared to 2500 mL (RIC 1000 mL) in patients with obstetric shock index ‹ 0.9 (p = 0.04). Women with obstetric shock index ≥ 0.9 showed more significant requirement of transfusion of package red blood (p = 0.03) and platelets (p = 0.01).
Conclusions: An obstetric shock index ≥0.9 was associated with high transfusion requirements and a higher incidence of serious adverse events, this value is recommended as the cut-off point for predicting the need for massive transfusion.


REFERENCES

  1. Cantwell R, et al. Saving Mothers' Lives: Reviewing maternal deaths to make motherhood safer: 2006-2008 BJOG. 2011;118 Suppl 1:1-203. https://doi.org/10.1111/j.1471- 0528.2011.03097.x

  2. Stafford I, et al. Visually estimated and calculated blood loss in vaginal and cesarean delivery. Am J Obstet Gynecol. 2008;199:519.e1-7. https://doi.org/10.1016/j. ajog.2008.04.049

  3. El Ayadi AM, et al. Vital Sign Prediction of Adverse Maternal Outcomes in Women with Hypovolemic Shock: The Role of Shock Index. PLoS ONE. 2016;22:11(2):e0148729. https:// doi.org/10.1371/journal.pone.0148729

  4. Le Bas 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(3):253-55. https://doi.org/10.1016/j. ijgo.2013.08.020

  5. Mavrides E, et al. Prevention and management of postpartum haemorrhage. BJOG 2016;124:e106–e149. DOI: 10.1111/1471-0528.14178

  6. Sihler KC, et al. Massive transfusion: new insights. Chest. 2009;136:1654-67. https://doi.org/10.1378/chest.09-0251

  7. Zunini-Fernandez G, et al. Massive transfusion and trauma patient management: pathophysiological approach to treatment. Cir Cir. 2011;79:473-80.

  8. Sheikh L, et al. Evaluation of compliance and outcomes of a management protocol for massive postpartum hemorrhage at a tertiary care hospital in Pakistan. BMC Pregnancy Childbirth. 2011;11:28. https://doi.org/10.1186/1471-2393-11-28

  9. Mitra B, et al. The definition of massive transfusion in trauma: a critical variable in examining evidence for resuscitation. Eur J Emerg Med. 2011;18(3):137-42. doi: 10.1097/MEJ.0b013e328342310e

  10. Moore J, et al. Management of massive postpartum hemorrhage and coagulopathy. Obstet Gynaecol Reprod Med. 2010;20:174-180. https://doi.org/10.1016/j. ogrm.2010.03.005

  11. Mutschler M, et al. The Shock Index revisited - a fast guide to transfusion requirement? A retrospective analysis on 21,853 patients derived from the Trauma Register DGU. Crit Care. 2013;17(4):R172. https://doi.org/10.1186/cc12851

  12. Hagiwara A, et al. Hemodynamic reactions in patients with hemorrhagic shock from blunt trauma after initial fluid therapy. J Trauma 2010;69:1161–8. doi: 10.1097/ TA.0b013e3181d27c94

  13. Vandromme MJ, et al. Identifying risk for massive transfusion in the relatively normotensive patient: utility of the prehospital shock index. J Trauma. 2011;70:384-8. doi: 10.1097/TA.0b013e3182095a0a

  14. Nathan HL, et al. Shock index: an effective predictor of outcome in postpartum haemorrhage? BJOG. 2015;122(2):268- 75. https://doi.org/10.1111/1471-0528.13206

  15. Sohn CH, et al. An increase in initial shock index is associated with the requirement for massive transfusion in emergency department patients with primary postpartum hemorrhage. Shock. 2013;40(2):101-5. doi: 10.1097/ SHK.0b013e31829b1778

  16. Fröhlich M, et al. Is the index based classification of hypovolemic shock applicable in multiple injured patients with severe traumatic brain injury? An analysis of the Trauma- Register DGU. Resuscitation and Emergency Medicine. 2016; 24:148. https://doi.org/10.1186/s13049-016-0340-2

  17. Nathan HL, 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(12):e0168535. https://doi.org/10.1371/journal. pone.0168535




2020     |     www.medigraphic.com