Shock Index In Obstetric Hemorrhage As An Applicable Method To Anticipate Adverse Outcome

Abstract Background: To establish the ability of shock index and the different vital signs to predict the adverse maternal outcomes in the cases of obstetric hemorrhage . Methods: This prospective - retrospective study comprised patients with primary PPH or hemorrhage due to obstetric cause who were referred to zagazig University hospital Egypt , from January 2018, to December 2019 Data of vital signs of them ; systolic and diastolic blood pressure, pulse rate, pulse pressure, mean arterial pressure and shock index (heart rate divided by systolic blood pressure) at time of arrival were investigated . Adverse outcome like ,death , admission to the intensive care unit , massive transfusion and invasive procedures were revised and analyzed. AUROC (area under the receiver operating characteristic curve ) was used for shock index in comparison to each vital sign for predicting the adverse maternal outcomes. Sensitivity, specificity, and negative and positive predictive values were assessed to detect the best predictor.Results: The mean age of participants years (SD)was 29.2 ( ±7.3) of admission and 44% had altered. The most Common cause of hemorrhage was Iatrogenic ; either misuse of uterotonic or traumatic 30.2% The mean value of HR 108.1±26.6 , SBP 101± 28.7 mmHg , DBP 58.9±21.3 mmHg , SI 1.153±0.541 and mean blood loss 1922 (0.862) .For death, SI and SBP had the highest AUC value at 0.88 (0.81–0.95) with P=0.213). For ICU blood transfusion ≥ 5iu , admission and invasive surgical interventions, SI had the uppermost AUROC value at 0.76, 0.78 and 0.61. Sensitivity for all adverse outcomes of SI ≥ 0.7,is h from 99 to 90.0 . For death prediction SI≥ 0.7 had very low specificity ;0.6{0.2-1.3}and of SI ≥ 0.9 ;6.4{2.8-7.1}Conclusion: Shock index is a strapping applicable predictor of adverse outcomes. for patients who suffering from hypovolemic shock due to obstetric hemorrhage,