Date Published: June 11, 2019
Publisher: Public Library of Science
Author(s): Anderson Borovac-Pinheiro, Filipe Moraes Ribeiro, Sirlei Siani Morais, Rodolfo Carvalho Pacagnella, Christine E. East.
To determine Shock Index (SI) reference values in the first two hours of the postpartum period after objectively measuring postpartum bleeding.
A complementary analysis using data from a prospective cohort study at Women’s Hospital of the University of Campinas, Brazil, between 1 February 2015 and 31 March 2016. It included women giving birth vaginally unless they had one of these conditions: gestational age below 34 weeks, hypertension, hypo- or hyperthyroidism without treatment, any cardiac disease, infections with fever or sepsis, history of coagulopathy or delivery by C-section. Blood loss was measured by adding the blood volume collected in the drape placed under the women’s buttocks and the weight of gauzes and compresses used (excluding the dry weight). Vital signs were measured every 5–15 min after delivery. Exploratory data analysis was performed to assess the mean, standard deviation, median, and percentiles (5th, 10th, 25th, 50th, 75th, 90th, 95th). To identify variation among the periods after delivery, the mean SI and heart rate (HR) values observed for the following intervals were used in the analysis: 0–20 min, 21–40 min, 41–60 min, 61–90 min and 91–120 min.
One hundred eighty-six women were included. The mean age ± SD was 24.9 ± 6.1 years and the mean gestational age at birth was 39.2 ± 1.8 weeks. At the puerperal period, the mean SI values ranged from 0.68 ± 0.14 to 0.74 ± 0.15. The percentile distribution ranged from 0.46 (5th percentile) to 1.05 (95th percentile). The mean HR values ranged from 80.8 ± 12.7 bpm to 92.3 ± 14.4 bpm. The percentile distribution ranged from 62.0 bpm (5th percentile) to 117 bpm (95th percentile).
Reference ranges were established for SI and HR values which showed small variations throughout the postpartum period.
Bleeding associated with childbirth and the postpartum period is the leading cause of postpartum maternal death and morbidity worldwide . In 2015, the worldwide postpartum maternal mortality rate was 195 deaths per 100,000 live births, while in Brazil the estimated rate was 65 deaths per 100,000 live births . About 80% of postpartum maternal deaths in low-income countries are related to postpartum haemorrhage (PPH) . PPH also plays a significant role in maternal morbidity related to ICU patient admission, massive transfusion of blood products, and renal and respiratory failure [2,3].
We performed a complementary analysis using data from a prospective cohort study that we conducted at Women’s Hospital of the University of Campinas, Brazil, between 1 February 2015 and 31 March 2016. In the cohort study, we included all women giving birth vaginally unless they had one of these conditions: gestational age below 34 weeks, hypertension, hypo- or hyperthyroidism without treatment, any cardiac disease, infections with fever or sepsis, history of coagulopathy, or postpartum bleeding greater than 500 mL.
Among the 270 women in the cohort study, 186 had blood loss less than 500 mL within 2 hours after birth and were included in the present study. Sociodemographic and obstetric characteristics are described in Table 1. The mean age ± SD was 24.9 ± 6.1 years and the mean gestational age at birth was 39.2 ± 1.8 weeks.
Our study aimed to evaluate the range of SI and HR values within 2 hours after delivery. The data showed that SI and HR values were higher within 20 min after delivery and tended to decrease over time. The values were influenced by BMI, yet maternal age does not show influence among the values founded.