Shock Index in the Prediction of Adverse Maternal Outcome
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ORIGINAL ARTICLE
Shock Index in the Prediction of Adverse Maternal Outcome Monika Chaudhary1 · Nandita Maitra1 · Tosha Sheth1 · Palak Vaishnav1 Received: 15 February 2020 / Accepted: 8 July 2020 © Federation of Obstetric & Gynecological Societies of India 2020
Abstract Introduction WHO states that obstetric hemorrhage, hypertensive disorders of pregnancy and sepsis account for approximately 50% of maternal deaths worldwide. All these conditions are associated with changes in vital signs including blood pressure (BP) and heart rate (HR). Shock index (SI) is the ratio of HR to systolic BP. Aims and Objectives To evaluate role of shock index as an early indicator of adverse maternal outcomes and to determine the threshold points of SI for five adverse maternal outcomes. Methodology This was a prospective observational study on 1004 consecutively enrolled subjects presenting in labor. Vital signs and Shock Index were recorded. SI thresholds were analyzed with respect to obstetric complications and adverse outcomes. Parametric tests such as Chi-square, comparison of proportions, comparison of mean and ROC curve analysis were applied on the data. Results The mean SI value in the vaginal delivery group was 1.02 ± 0.26 and it was 0.95 ± 0.033 in the caesarean delivery group. The values of SI ((Mean and SD) for ICU admission were (1.23 (± 0.35)), for (MODS) it was (1.47 (± 0.84)), for blood transfusion > 4 units it was (1.15 (± 0.41)), for surgical intervention it was (1.58 (± 0.51)) and for maternal death (1.39 (± 0.85)). SI ≥ 1.4, had sensitivity 26.82% (21.09–33.19); specificity 100%(99.53–100), PPV was 100% and NPV was 82.96%(81.8–84.06)with an AUC of 0.8 (0.78–0.83) on ROC analysis. In subjects with PIH/eclampsia, SI was lower and in patients with severe anemia, SI was higher Conclusion SI performed well as a screening tool in the prediction of adverse maternal outcomes. SI ≥ 0.9 was significantly associated with maternal adverse outcomes: ICU admission, MODS, surgical intervention, blood transfusion and death. The study proposes an SI cut-off of 0.9 for referral and a cut-off of 1.1 for intervention in a tertiary care hospital. Patients with PIH/eclampsia tend to have lower mean SI values as compared to the rest of the study population, suggesting that SI may not be a reliable indicator in patients with PIH/eclampsia Keywords Shock index · Adverse · Maternal outcome
Introduction WHO in a systematic review of causes of maternal mortality, states that obstetric hemorrhage, hypertensive disorders of pregnancy (HTN) and sepsis account for approximately 50% of maternal deaths worldwide [1]. Pregnancy involves significant hemodynamic changes. As the placenta is delivered, auto transfusion results in cardiac output increasing to 80% above pre-pregnancy values. It is during the intrapartum and immediate post-partum period that hemorrhage * Nandita Maitra [email protected] 1
Department of Obstetrics and Gynecology, Medical College and SSG Hospital, Vadodara, Gujarat, India
and sepsis is most prevalent and co
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