Shock index as a predictor of maternal outcome in postpartum hemorrhage: an experience from a tertiary care centre in Northern India

Introduction: Postpartum hemorrhage (PPH) is one of the commonest causes of maternal morbidity and mortality. Serious adverse outcomes mostly occur due to delays in the recognition and management of massive PPH. Shock index (SI) has been proposed as an early diagnostic indicator to monitor PPH women. Aims and objectives: To study SI as a predictor of maternal outcome in PPH patients. Patients and methods: This retrospective study was conducted over a duration of 1year (January 2021- December 2021) on the cohort of patients having PPH at the department of obstetrics and gynecology at a tertiary care hospital in northern India. The Age, parity, number of pregnancies, booked/unbooked pregnancy, singleton/multiple pregnancies, mode of delivery (vaginal or caesarean section), SI, blood transfusions, type and severity of PPH, type of management- medical/surgical, ICU admissions and maternal outcomes were recorded. Results: This study included a total of 105 women with PPH for analysis. 43.8% of patients had severe PPH and required massive blood transfusion > 4 units while 40% required ICU admission. 68 patients had S.I>0.9 while 46 patients had S.I>1.1. The value of S.I>1.1 correlated significantly with all studied adverse outcomes like ICU admission, massive blood loss, massive blood transfusion, and need for surgical intervention(p value<0.05). SI value of ≥1.1 had maximum sensitivity and specificity. Conclusion: The shock index seems to be an easy, practical, and effective clinical method for predicting adverse outcomes objectively in postpartum hemorrhage patients. Our study suggests a cut-off value of 1.1 for predicting adverse clinical outcomes.