Publication: Evaluation of obstetric shock index in identifying outcome of primary postpartum haemorrhage
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Date
2022
Authors
Abidin, Shahida Zainal
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Abstract
Objective: To determine relationship between obstetric shock index and outcomes of primary postpartum haemorrhage. This study also aimed to determine proportion of blood transfusion, surgical intervention and ICU admission in relation to shock index. Methods: A retrospective cohort study which was conducted in the Obstetrics and Gynaecology Department, Hospital Sultan Ismail Johor Bahru. We reviewed 607 women who delivered vaginally at term from January 2015 till December 2020, with estimated blood loss of more than 500 mL. The highest shock index within 2 hours after onset of PPH is used for analysis. Adverse outcomes such as requirement of blood transfusion, surgical intervention (Bakri balloon, EUA and perineal repair, compression suture, arterial ligation and hysterectomy) and ICU admission were reviewed. Result: From this study, 607 women that had blood loss more than 500 mL were analysed but only 513 women met the inclusion criteria. However, 88 women had missing data thus only 425 women included in this study. Out of 425 women, majority of the race are Malay ethnicity (79.1%). Mean age is 29.4 years old (SD=5.47), majority are multiparity (57.2%) and BMI 25-29.9kg/m22 (33.4%). Most common mode of delivery in this study are spontaneous vaginal delivery (69.9%). Most of postpartum haemorrhage started immediately after the birth (96.7%), 64.7% required blood transfusion, 11.3% required surgical intervention and 3.1% required ICU admission. The most common cause of PPH was uterine atony (59.8%) and there was 1 case of maternal mortality. There is significant difference (P<0.001) in obstetric shock index 1.2 that required blood transfusion compared to obstetric shock index 0.8 that did not required blood transfusion, obstetric shock index 1.1 that required surgical intervention compared to obstetric shock index 0.9 that did not required surgical intervention and obstetric shock index 1.8 that required ICU admission compared to obstetric shock index 0.9 that did not required ICU admission. The proportion of patients required blood transfusion is 35.3%, getting surgical intervention is 10.8% and admitted to ICU is 4.3%. Shock index consistently more accurate to predict requirement of blood transfusion 95% (93-98%), surgical intervention 76% (68-83%) and ICU admission 96%, (93-99%). The obstetric shock index ≥0.9 is a good predictor all adverse outcomes, except ICU admission. Obstetric shock index ≥1.8 showed a potentially severe outcome and need ICU admission. Conclusion: From this study, we conclude that SI consistently is a strong predictor of adverse clinical outcomes. We propose threshold of SI ≥0.9 is to alert medical personnel and require prompt action, SI ≥1.1 require intervention such as blood transfusion and surgical intervention while SI ≥1.8 is potentially severe outcome of patient that require ICU admission.
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Keywords
Postpartum haemorrhage , obstetric shock index