Shock index and vital-sign reference ranges during the immediate postpartum period

Taylor, Dyese; Fleischer, Adiel; Meirowitz, Natalie; Rosen, Lisa

doi:10.1002/ijgo.12127

Cited by 18 publications

(23 citation statements)

References 8 publications

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“…To our knowledge, the study is the first to prospectively determine the normal range of SI and other vital signs in the immediate postpartum period. Previous studies evaluating normal ranges of SI were either retrospective studies or a secondary analysis of prospective observational studies 12,15 ; in addition, some studies used time points beyond the first hour despite the WHO recommendation for adequate monitoring of postpartum women to commence within the first hour of delivery 16 . Furthermore, other studies derived the normal range of SI from populations in high‐income countries.…”

Section: Discussionmentioning

confidence: 99%

What is the normal range of obstetric shock index in the immediate postpartum period in a low‐resource setting?

Nwafor

Nobert

Onuorah

et al. 2020

Intl J Gynecology & Obste

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Objective To determine the normal range of shock index (SI), blood pressure (BP), mean arterial pressure (MAP) and heart rate (HR) among postpartum women in a low‐resource setting. Methods In a prospective cohort study, vital signs were recorded 1 hour after delivery among postpartum women with normal blood loss who delivered in Abakaliki, Nigeria, from April to July 2019. Results Among 225 women, the median (95% reference range) was 120 (100–155.8), 70 (60–94), and 90 (66.5–116.6) mm Hg for systolic BP, diastolic BP, and MAP, respectively; 82 (65–102) bpm for HR; and 0.69 (0.48–0.89) for SI. The upper SI limit of 0.89 supported the current value of 0.9 as the upper limit; however, the lower SI limit of 0.48 corresponded to the current lower limit for a non‐obstetric population (0.5). The SI of more than half of the study women (n=126; 56.0%) was within the normal range for non‐obstetric women (0.5–0.7). Conclusion Although hemodynamic changes in pregnancy widen the SI range, 56.0% of women maintained SI within the non‐obstetric reference range. In low‐resource settings, the current normal obstetric SI range of 0.7–0.9 should be revised to 0.5–0.9 to accommodate this lower threshold.

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Section: Discussionmentioning

confidence: 99%

What is the normal range of obstetric shock index in the immediate postpartum period in a low‐resource setting?

Nwafor

Nobert

Onuorah

et al. 2020

Intl J Gynecology & Obste

View full text Add to dashboard Cite

show abstract

“…This study is unique in that it is the first study to prospectively determine the normal range of shock index and other vital signs in the immediate postpartum period. Previous studies evaluating normal ranges of shock index were either retrospective studies or secondary analysis of prospective observational studies [12][13][14] and some have used time points beyond the first hour despite the World Health Organization recommendation on the need for adequate monitoring of postpartum women to commence within the first hour of birth [15]. In addition, this is the first study to evaluate normal ranges of shock index in a low-resource setting as values from other studies were derived from women in high income countries.…”

Section: Discussionmentioning

confidence: 99%

What is the normal range of obstetric shock index in the immediate postpartum period in a low resource setting?

Nwafor

Nobert

Onuorah

et al. 2020

Preprint

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Objective: To determine the normal range of shock index (SI), blood pressure (BP), mean arterial pressure (MAP) and heart rate (HR) among postpartum women and to compare shock index with the normal range in the current literature.Methods: This is a prospective cohort study evaluating vital signs collected at one hour of delivery in women with normal blood loss delivered in Abakaliki, Nigeria. Results: The median (95% reference range) was 120 (100 - 155.8) for systolic BP, 70 (60 - 94) for diastolic BP, 90 (66.5 - 116.6) for MAP, 82 (65 - 102) for HR, and 0.69 (0.48 - 0.89) for SI. The upper limit of SI of 0.89 in this study did support the current literature suggesting a threshold of 0.9 as upper limit of normal. However, the lower limit of SI of 0.48 in this study corresponds to the lower limit of 0.5 for non-obstetric population. Over half (56%) of the study cohorts maintained shock index values within the normal range (0.5 - 0.7) for non-obstetric population. Conclusion: Although haemodynamic changes of pregnancy widens the range of shock index in obstetric population, 56% of the participants maintained normal shock index within the reference range for non-obstetric population. We recommend that the normal obstetric shock index range of 0.7 - 0.9 in current literature be changed to 0.5 - 0.9 to accommodate this lower threshold.

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“…In the non‐pregnant population, a shock index > 1.0, thus a higher heart rate than systolic blood pressure measured at least once in the observation period, has been associated with morbidity and mortality in critically ill patients suffering trauma, sepsis and after surgery . A study among 8874 women without postpartum hemorrhage reported a range of 0.5 to 1.1 for the shock index immediately following delivery . Another study among 233 women with postpartum hemorrhage with blood loss exceeding 1500 mL concluded that a shock index ≥ 1.7 was a predictor of intensive care unit admission, invasive surgical procedures and transfusion of ≥ 4 units of packed red blood cells, with respective area under the curves 0.75 (95% confidence interval [CI] 0.63–0.87), 0.62 (0.45–0.79) and 0.67 (0.58–0.76) .…”

Section: Improving Maternal Outcomes: Timely Recognition Of Patients mentioning

confidence: 99%

Management of postpartum hemorrhage: how to improve maternal outcomes?

Henriquez

Bloemenkamp

Bom

2018

Journal of Thrombosis and Haemostasis

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Postpartum hemorrhage is the leading cause of maternal mortality and severe morbidity. Despite efforts to improve maternal outcomes, management of postpartum hemorrhage still faces at least four challenges, discussed in this review. First, current definitions for severe postpartum hemorrhage hamper early identification of women with a high risk of adverse outcomes. Adaptations to the definitions and the use of clinical tools such as shock index and early warning systems may facilitate this early identification. Second, surgical and radiological interventions to prevent hysterectomy are not always successful. More knowledge on the influence of patient and bleeding characteristics on the success rates of these interventions is necessary. Scarce data suggest that early timing of intrauterine balloon tamponade may improve maternal outcomes, whereas early timing of arterial embolization seems to be unrelated to maternal outcomes. Third, fluid resuscitation with crystalloids and colloids is unavoidable in the early phases of postpartum hemorrhage but may result in dilutional coagulopathy. Effects of different volumes of clear fluids on the occurrence of dilutional coagulopathy and maternal outcomes is unknown. Fourth, a better understanding of diagnosis and correction of coagulopathy during postpartum hemorrhage is needed. Low plasma fibrinogen levels at the start of postpartum hemorrhage predict progression to severe hemorrhage, but standard coagulation screens are time consuming. A solution may be point-of-care coagulation testing; however, clinical usefulness during postpartum hemorrhage has not been demonstrated. To date, early administration of tranexamic acid is the only hemostatic intervention that was proven to improve outcomes in women with postpartum hemorrhage.

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Shock index and vital-sign reference ranges during the immediate postpartum period

Abstract: Specific reference ranges for patients during the postpartum period could be used in future studies to determine the parameters, or combinations of parameters, that perform best as early markers of hemodynamic compromise in women experiencing early postpartum hemorrhage.

Cited by 18 publications

References 8 publications

What is the normal range of obstetric shock index in the immediate postpartum period in a low‐resource setting?

What is the normal range of obstetric shock index in the immediate postpartum period in a low‐resource setting?

What is the normal range of obstetric shock index in the immediate postpartum period in a low resource setting?

Management of postpartum hemorrhage: how to improve maternal outcomes?

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