José Rojas-Suarez1,2,3,4, Ángel Paternina-Caicedo2, Jorge E Tolosa5,6,7, Leidy Guzmán-Polanía2, Nataly Gonzalez2, Fredy Pomares1,2, Augusto Maza1,2, Jezid Miranda2. 1. Department of Internal Medicine, Universidad de Cartagena, Cartagena, Colombia. 2. Grupo de Investigación en Cuidado Intensivo y Obstetricia (GRICIO), Cartagena, Colombia. 3. Unidad de Cuidados Intensivos Gestión Salud, Cartagena, Colombia. 4. ESE Clínica de Maternidad Rafael Calvo (CMRC), Cartagena de Indias, Colombia. 5. Global Network for Perinatal and Reproductive Health, Oregon Health and Science University, Portland, USA, FUNDARED-MATERNA, Bogotá, Colombia. 6. Department of Obstetrics and Gynecology, Oregon Health and Science University, Portland, OR, USA. 7. Department of Obstetrics and Gynecology, Universidad de Antioquia, Medellin, Colombia.
Abstract
BACKGROUND: The Shock Index is a clinical tool to evaluate the hemodynamic status during hemorrhage. The impact of labor and pre-existing anaemia is unknown. The objective was to describe and discuss its clinical utility in this context. METHODS: This was a prospective cross-sectional study. The Shock Index (ratio between heart rate and systolic blood pressure) was measured in pregnant women at term, before or during labor. They were stratified according to the presence of anemia. RESULTS: The median Shock Index was significantly lower in women in labor than in those not in labor (0.72 (IQR: 0.64-0.83) vs. 0.85 (IQR: 0.80-0.94); p < 0.001). In women in labor, the Shock Index was not significantly different if anemia was present (0.72 (0.63-0.83) vs. 0.73 (0.65-0.82); p = 0.67). CONCLUSIONS: Values of the Shock Index are affected by labor, which may hinder its utility in identifying hemorrhage during this period. However, the values were not altered by maternal anaemia. Therefore, an abnormal postpartum Shock Index should not be attributed to an abnormal antepartum Shock Index due to mild/moderate anemia.
BACKGROUND: The Shock Index is a clinical tool to evaluate the hemodynamic status during hemorrhage. The impact of labor and pre-existing anaemia is unknown. The objective was to describe and discuss its clinical utility in this context. METHODS: This was a prospective cross-sectional study. The Shock Index (ratio between heart rate and systolic blood pressure) was measured in pregnant women at term, before or during labor. They were stratified according to the presence of anemia. RESULTS: The median Shock Index was significantly lower in women in labor than in those not in labor (0.72 (IQR: 0.64-0.83) vs. 0.85 (IQR: 0.80-0.94); p < 0.001). In women in labor, the Shock Index was not significantly different if anemia was present (0.72 (0.63-0.83) vs. 0.73 (0.65-0.82); p = 0.67). CONCLUSIONS: Values of the Shock Index are affected by labor, which may hinder its utility in identifying hemorrhage during this period. However, the values were not altered by maternal anaemia. Therefore, an abnormal postpartum Shock Index should not be attributed to an abnormal antepartum Shock Index due to mild/moderate anemia.
Authors: Prasanna Sankaran; Ajay V Kamath; Syed M Tariq; Hannah Ruffell; Alexandra C Smith; Philippa Prentice; Deepak N Subramanian; Patrick Musonda; Phyo K Myint Journal: Eur J Intern Med Date: 2011-01-17 Impact factor: 4.487
Authors: Nicholas J Kassebaum; Amelia Bertozzi-Villa; Megan S Coggeshall; Katya A Shackelford; Caitlyn Steiner; Kyle R Heuton; Diego Gonzalez-Medina; Ryan Barber; Chantal Huynh; Daniel Dicker; Tara Templin; Timothy M Wolock; Ayse Abbasoglu Ozgoren; Foad Abd-Allah; Semaw Ferede Abera; Ibrahim Abubakar; Tom Achoki; Ademola Adelekan; Zanfina Ademi; Arsène Kouablan Adou; José C Adsuar; Emilie E Agardh; Dickens Akena; Deena Alasfoor; Zewdie Aderaw Alemu; Rafael Alfonso-Cristancho; Samia Alhabib; Raghib Ali; Mazin J Al Kahbouri; François Alla; Peter J Allen; Mohammad A AlMazroa; Ubai Alsharif; Elena Alvarez; Nelson Alvis-Guzmán; Adansi A Amankwaa; Azmeraw T Amare; Hassan Amini; Walid Ammar; Carl A T Antonio; Palwasha Anwari; Johan Arnlöv; Valentina S Arsic Arsenijevic; Ali Artaman; Majed Masoud Asad; Rana J Asghar; Reza Assadi; Lydia S Atkins; Alaa Badawi; Kalpana Balakrishnan; Arindam Basu; Sanjay Basu; Justin Beardsley; Neeraj Bedi; Tolesa Bekele; Michelle L Bell; Eduardo Bernabe; Tariku J Beyene; Zulfiqar Bhutta; Aref Bin Abdulhak; Jed D Blore; Berrak Bora Basara; Dipan Bose; Nicholas Breitborde; Rosario Cárdenas; Carlos A Castañeda-Orjuela; Ruben Estanislao Castro; Ferrán Catalá-López; Alanur Cavlin; Jung-Chen Chang; Xuan Che; Costas A Christophi; Sumeet S Chugh; Massimo Cirillo; Samantha M Colquhoun; Leslie Trumbull Cooper; Cyrus Cooper; Iuri da Costa Leite; Lalit Dandona; Rakhi Dandona; Adrian Davis; Anand Dayama; Louisa Degenhardt; Diego De Leo; Borja del Pozo-Cruz; Kebede Deribe; Muluken Dessalegn; Gabrielle A deVeber; Samath D Dharmaratne; Uğur Dilmen; Eric L Ding; Rob E Dorrington; Tim R Driscoll; Sergei Petrovich Ermakov; Alireza Esteghamati; Emerito Jose A Faraon; Farshad Farzadfar; Manuela Mendonca Felicio; Seyed-Mohammad Fereshtehnejad; Graça Maria Ferreira de Lima; Mohammad H Forouzanfar; Elisabeth B França; Lynne Gaffikin; Ketevan Gambashidze; Fortuné Gbètoho Gankpé; Ana C Garcia; Johanna M Geleijnse; Katherine B Gibney; Maurice Giroud; Elizabeth L Glaser; Ketevan Goginashvili; Philimon Gona; Dinorah González-Castell; Atsushi Goto; Hebe N Gouda; Harish Chander Gugnani; Rahul Gupta; Rajeev Gupta; Nima Hafezi-Nejad; Randah Ribhi Hamadeh; Mouhanad Hammami; Graeme J Hankey; Hilda L Harb; Rasmus Havmoeller; Simon I Hay; Ileana B Heredia Pi; Hans W Hoek; H Dean Hosgood; Damian G Hoy; Abdullatif Husseini; Bulat T Idrisov; Kaire Innos; Manami Inoue; Kathryn H Jacobsen; Eiman Jahangir; Sun Ha Jee; Paul N Jensen; Vivekanand Jha; Guohong Jiang; Jost B Jonas; Knud Juel; Edmond Kato Kabagambe; Haidong Kan; Nadim E Karam; André Karch; Corine Kakizi Karema; Anil Kaul; Norito Kawakami; Konstantin Kazanjan; Dhruv S Kazi; Andrew H Kemp; Andre Pascal Kengne; Maia Kereselidze; Yousef Saleh Khader; Shams Eldin Ali Hassan Khalifa; Ejaz Ahmed Khan; Young-Ho Khang; Luke Knibbs; Yoshihiro Kokubo; Soewarta Kosen; Barthelemy Kuate Defo; Chanda Kulkarni; Veena S Kulkarni; G Anil Kumar; Kaushalendra Kumar; Ravi B Kumar; Gene Kwan; Taavi Lai; Ratilal Lalloo; Hilton Lam; Van C Lansingh; Anders Larsson; Jong-Tae Lee; James Leigh; Mall Leinsalu; Ricky Leung; Xiaohong Li; Yichong Li; Yongmei Li; Juan Liang; Xiaofeng Liang; Stephen S Lim; Hsien-Ho Lin; Steven E Lipshultz; Shiwei Liu; Yang Liu; Belinda K Lloyd; Stephanie J London; Paulo A Lotufo; Jixiang Ma; Stefan Ma; Vasco Manuel Pedro Machado; Nana Kwaku Mainoo; Marek Majdan; Christopher Chabila Mapoma; Wagner Marcenes; Melvin Barrientos Marzan; Amanda J Mason-Jones; Man Mohan Mehndiratta; Fabiola Mejia-Rodriguez; Ziad A Memish; Walter Mendoza; Ted R Miller; Edward J Mills; Ali H Mokdad; Glen Liddell Mola; Lorenzo Monasta; Jonathan de la Cruz Monis; Julio Cesar Montañez Hernandez; Ami R Moore; Maziar Moradi-Lakeh; Rintaro Mori; Ulrich O Mueller; Mitsuru Mukaigawara; Aliya Naheed; Kovin S Naidoo; Devina Nand; Vinay Nangia; Denis Nash; Chakib Nejjari; Robert G Nelson; Sudan Prasad Neupane; Charles R Newton; Marie Ng; Mark J Nieuwenhuijsen; Muhammad Imran Nisar; Sandra Nolte; Ole F Norheim; Luke Nyakarahuka; In-Hwan Oh; Takayoshi Ohkubo; Bolajoko O Olusanya; Saad B Omer; John Nelson Opio; Orish Ebere Orisakwe; Jeyaraj D Pandian; Christina Papachristou; Jae-Hyun Park; Angel J Paternina Caicedo; Scott B Patten; Vinod K Paul; Boris Igor Pavlin; Neil Pearce; David M Pereira; Konrad Pesudovs; Max Petzold; Dan Poenaru; Guilherme V Polanczyk; Suzanne Polinder; Dan Pope; Farshad Pourmalek; Dima Qato; D Alex Quistberg; Anwar Rafay; Kazem Rahimi; Vafa Rahimi-Movaghar; Sajjad ur Rahman; Murugesan Raju; Saleem M Rana; Amany Refaat; Luca Ronfani; Nobhojit Roy; Tania Georgina Sánchez Pimienta; Mohammad Ali Sahraian; Joshua A Salomon; Uchechukwu Sampson; Itamar S Santos; Monika Sawhney; Felix Sayinzoga; Ione J C Schneider; Austin Schumacher; David C Schwebel; Soraya Seedat; Sadaf G Sepanlou; Edson E Servan-Mori; Marina Shakh-Nazarova; Sara Sheikhbahaei; Kenji Shibuya; Hwashin Hyun Shin; Ivy Shiue; Inga Dora Sigfusdottir; Donald H Silberberg; Andrea P Silva; Jasvinder A Singh; Vegard Skirbekk; Karen Sliwa; Sergey S Soshnikov; Luciano A Sposato; Chandrashekhar T Sreeramareddy; Konstantinos Stroumpoulis; Lela Sturua; Bryan L Sykes; Karen M Tabb; Roberto Tchio Talongwa; Feng Tan; Carolina Maria Teixeira; Eric Yeboah Tenkorang; Abdullah Sulieman Terkawi; Andrew L Thorne-Lyman; David L Tirschwell; Jeffrey A Towbin; Bach X Tran; Miltiadis Tsilimbaris; Uche S Uchendu; Kingsley N Ukwaja; Eduardo A Undurraga; Selen Begüm Uzun; Andrew J Vallely; Coen H van Gool; Tommi J Vasankari; Monica S Vavilala; N Venketasubramanian; Salvador Villalpando; Francesco S Violante; Vasiliy Victorovich Vlassov; Theo Vos; Stephen Waller; Haidong Wang; Linhong Wang; XiaoRong Wang; Yanping Wang; Scott Weichenthal; Elisabete Weiderpass; Robert G Weintraub; Ronny Westerman; James D Wilkinson; Solomon Meseret Woldeyohannes; John Q Wong; Muluemebet Abera Wordofa; Gelin Xu; Yang C Yang; Yuichiro Yano; Gokalp Kadri Yentur; Paul Yip; Naohiro Yonemoto; Seok-Jun Yoon; Mustafa Z Younis; Chuanhua Yu; Kim Yun Jin; Maysaa El Sayed Zaki; Yong Zhao; Yingfeng Zheng; Maigeng Zhou; Jun Zhu; Xiao Nong Zou; Alan D Lopez; Mohsen Naghavi; Christopher J L Murray; Rafael Lozano Journal: Lancet Date: 2014-05-02 Impact factor: 79.321
Authors: Hannah L Nathan; Kate Cottam; Natasha L Hezelgrave; Paul T Seed; Annette Briley; Susan Bewley; Lucy C Chappell; Andrew H Shennan Journal: PLoS One Date: 2016-12-20 Impact factor: 3.240
Authors: Ole F Norheim; Prabhat Jha; Kesetebirhan Admasu; Tore Godal; Ryan J Hum; Margaret E Kruk; Octavio Gómez-Dantés; Colin D Mathers; Hongchao Pan; Jaime Sepúlveda; Wilson Suraweera; Stéphane Verguet; Addis T Woldemariam; Gavin Yamey; Dean T Jamison; Richard Peto Journal: Lancet Date: 2014-09-18 Impact factor: 79.321
Authors: Rodolfo Carvalho Pacagnella; João Paulo Souza; Jill Durocher; Pablo Perel; Jennifer Blum; Beverly Winikoff; Ahmet Metin Gülmezoglu Journal: PLoS One Date: 2013-03-06 Impact factor: 3.240
Authors: Gretchen A Stevens; Mariel M Finucane; Luz Maria De-Regil; Christopher J Paciorek; Seth R Flaxman; Francesco Branca; Juan Pablo Peña-Rosas; Zulfiqar A Bhutta; Majid Ezzati Journal: Lancet Glob Health Date: 2013-06-25 Impact factor: 26.763