This clinical article evaluates the use of the "obstetric shock index" (OSI) in identifying significant blood loss in patients with massive postpartum hemorrhage. The OSI is calculated by dividing heart rate by systolic blood pressure. The study found that in patients with normal blood loss, the mean OSI was 0.74, suggesting the normal range is 0.7-0.9. Patients with massive blood loss had a higher mean OSI of 0.91. An OSI over 1.1 within 30 minutes of onset of bleeding correctly predicted the need for blood transfusion in 89% of cases. The authors conclude that an OSI over 1 can help identify significant blood loss and predict need for transfusion in cases of
Because of such a high consumption level, any risky impact of these pills on public health would be important. The present study aimed to determine the relationship between consumption of OCPs and hypertension. Method: In this retrospective, cross-sectional study, 165women below 40 years of age who used OCPs were selected by convenience sampling. Necessary information was obtained by a checklist containing demographic information, obstetric history, and OCPs use history based on the subjects’ medical records. Besides, blood pressure and weight were measured at the beginning of OCPs consumption as well as 6 months and one year after that. Results: The results showed a significant difference between the subjects’ mean systolic blood pressure one year after OCPs consumption compared to the beginning (P=0.03). Moreover, this difference was related to the type of pills, such a way that it was significant in the patients who took Low Dose (LD) OCPs compared to those who used Triphasic pills (P=0.01). Conclusion: Consuming the currently available OCPs that contain lower estrogen content had an insignificant effect on blood pressure. However, it is recommended to take care of blood pressure in order to identify the unique occasional responses.
A presentation by Max Bell at the 2017 meeting of the Scandinavian Society of Anaestesiology and Intensive Care Medicine.
All available content from SSAI2017: https://scanfoam.org/ssai2017/
Delivered in collaboration between scanFOAM, SSAI & SFAI.
Because of such a high consumption level, any risky impact of these pills on public health would be important. The present study aimed to determine the relationship between consumption of OCPs and hypertension. Method: In this retrospective, cross-sectional study, 165women below 40 years of age who used OCPs were selected by convenience sampling. Necessary information was obtained by a checklist containing demographic information, obstetric history, and OCPs use history based on the subjects’ medical records. Besides, blood pressure and weight were measured at the beginning of OCPs consumption as well as 6 months and one year after that. Results: The results showed a significant difference between the subjects’ mean systolic blood pressure one year after OCPs consumption compared to the beginning (P=0.03). Moreover, this difference was related to the type of pills, such a way that it was significant in the patients who took Low Dose (LD) OCPs compared to those who used Triphasic pills (P=0.01). Conclusion: Consuming the currently available OCPs that contain lower estrogen content had an insignificant effect on blood pressure. However, it is recommended to take care of blood pressure in order to identify the unique occasional responses.
A presentation by Max Bell at the 2017 meeting of the Scandinavian Society of Anaestesiology and Intensive Care Medicine.
All available content from SSAI2017: https://scanfoam.org/ssai2017/
Delivered in collaboration between scanFOAM, SSAI & SFAI.
Irina Gontschar and Igor Prudyvus
Abstract
Introduction: The purpose of the study is to provide information about the database of 1421 adult patients with acute ischemic stroke (IS) developing ≤ 48 hours before admitting, research methods, study protocol, and clinical predictors of the evolving stroke course (EIS).
Methods and Materials: EIS outlined as an increase of NIHSS ≥ 2 points within seven days or in-hospital lethal outcome. Clinical, demographic, instrumental, laboratory data acquisition, as well as the IS course variant and the functional outcome assessment, were carried out prospectively. Statistical analyses were performed using R V.3.2.5 statistical package software and IBM SPSS Statistics 26.0.
Results: The incidence of EIS reached 30.0%. The average age of patients with EIS was 72.6±10.2 years, compare the age of patients without EIS - 68.1±11.3 years; p = 0.005. Female sex increased the odds of EIS (OR, 1.36; 95% CI 1.08-1.73). Total anterior carotid stroke (OR, 7.78; 95% CI 5.91-10.23), the initial NIHSS score > 14 points (OR, 3.74; 95% CI 2.83-4.94), and the right anterior circulation was also associated with EIS (OR, 1.30; 95% CI 1.02-1.66). The odds of EIS were significantly higher in the presence of diabetes mellitus (OR, 1.29; 95% CI 1.01-1.66), cerebral artery stenosis ≥ 70% (OR, 1.96; 95% CI 1.30-2.93), atrial fibrillation (OR, 1.89; 95% CI 1.51-2.39), congestive heart failure (OR, 1.90; 95% CI 1.51-2.39), and peripheral artery disease (OR, 1.69; 95% CI 1.27-2.25). Respiratory (OR, 2.82; 95% CI 2.22-3.59), gastrointestinal (OR, 1.34; 95% CI 1.05-1.70), and urologic diseases (OR, 2.10; 95% CI 1.65-2.66), stroke-associated infection (OR, 3.47; 95% CI 2.09-5.76), and gradual development of initial IS symptoms before admitting increased the odds of progression of the neurological deficit during treatment (OR, 2.37; 95% CI 1.78-3.15)were associated with the evolving clinical course of IS. The patients with the EIS compared with patients without EIS, showed higher serum levels of glucose (p < 0.001), urea (p = 0.001), creatinine (p < 0.001), sodium (p = 0.025), and direct bilirubin (p = 0.015). Potassium level in EIS group was lower than in the group without EIS (p < 0.001). In patients with EIS, a higher amount of RBC (p = 0.030) and WBC (p < 0.001) was found.
Conclusion: The in-hospital database contains information about EIS by the bases subtypes of IS, patient demography, cardiovascular risk factors, comorbid pathology, clinical and laboratory tests, instrumental methods of examination, medications, the severity of neurological deficit, and post-stroke outcome.
Irina Gontschar and Igor Prudyvus
Abstract
Introduction: The purpose of the study is to provide information about the database of 1421 adult patients with acute ischemic stroke (IS) developing ≤ 48 hours before admitting, research methods, study protocol, and clinical predictors of the evolving stroke course (EIS).
Methods and Materials: EIS outlined as an increase of NIHSS ≥ 2 points within seven days or in-hospital lethal outcome. Clinical, demographic, instrumental, laboratory data acquisition, as well as the IS course variant and the functional outcome assessment, were carried out prospectively. Statistical analyses were performed using R V.3.2.5 statistical package software and IBM SPSS Statistics 26.0.
Results: The incidence of EIS reached 30.0%. The average age of patients with EIS was 72.6±10.2 years, compare the age of patients without EIS - 68.1±11.3 years; p = 0.005. Female sex increased the odds of EIS (OR, 1.36; 95% CI 1.08-1.73). Total anterior carotid stroke (OR, 7.78; 95% CI 5.91-10.23), the initial NIHSS score > 14 points (OR, 3.74; 95% CI 2.83-4.94), and the right anterior circulation was also associated with EIS (OR, 1.30; 95% CI 1.02-1.66). The odds of EIS were significantly higher in the presence of diabetes mellitus (OR, 1.29; 95% CI 1.01-1.66), cerebral artery stenosis ≥ 70% (OR, 1.96; 95% CI 1.30-2.93), atrial fibrillation (OR, 1.89; 95% CI 1.51-2.39), congestive heart failure (OR, 1.90; 95% CI 1.51-2.39), and peripheral artery disease (OR, 1.69; 95% CI 1.27-2.25). Respiratory (OR, 2.82; 95% CI 2.22-3.59), gastrointestinal (OR, 1.34; 95% CI 1.05-1.70), and urologic diseases (OR, 2.10; 95% CI 1.65-2.66), stroke-associated infection (OR, 3.47; 95% CI 2.09-5.76), and gradual development of initial IS symptoms before admitting increased the odds of progression of the neurological deficit during treatment (OR, 2.37; 95% CI 1.78-3.15)were associated with the evolving clinical course of IS. The patients with the EIS compared with patients without EIS, showed higher serum levels of glucose (p < 0.001), urea (p = 0.001), creatinine (p < 0.001), sodium (p = 0.025), and direct bilirubin (p = 0.015). Potassium level in EIS group was lower than in the group without EIS (p < 0.001). In patients with EIS, a higher amount of RBC (p = 0.030) and WBC (p < 0.001) was found.
Conclusion: The in-hospital database contains information about EIS by the bases subtypes of IS, patient demography, cardiovascular risk factors, comorbid pathology, clinical and laboratory tests, instrumental methods of examination, medications, the severity of neurological deficit, and post-stroke outcome.
Abstract— Anemia in pregnancy is commonly considered as risk factor for poor pregnancy outcome and can threaten the maternal and fetal life also. So this present cases control study was carried at R. K. Joshi District Hospital Dausa (Rajasthan) India, with the aim to find out the effect of anemia in Antenatal period on pregnancy outcomes. For this study, 50 Antenatal Cases (ANCs) with anemia were selected as study group among ANCs attending for delivery in district hospital Dausa. For control group age and BMI matched 50 normal healthy ANCs without anemia were selected from the same area. ANCs with any other diseases were excluded from the study. It was found in this study that although proportion of ANCs with LSCS, PPH and Sepsis were higher in anemic ANCs but it was not found significant. Likewise IUGR, LBW babies, premature births and still births were more in anemic ANCs but it was found significant only in case of LBW babies. So it can be concluded that anemia in ANCs effect weight of newborn babies born by ANC with anemia.
Stratified Management of Cardiac Surgery for Structural Heart Disease during ...semualkaira
We study pregnancy outcomes of cardiac surgery
under cardiopulmonary bypass (CPB) at different stages and discuss stratified management of cardiac surgery under CPB in pregnant women with structural heart disease (SHD) from pre-pregnancy counseling through postpartum management.
Stratified Management of Cardiac Surgery for Structural Heart Disease during ...semualkaira
: We study pregnancy outcomes of cardiac surgery
under cardiopulmonary bypass (CPB) at different stages and discuss stratified management of cardiac surgery under CPB in pregnant women with structural heart disease (SHD) from pre-pregnancy counseling through postpartum management.
“A Study on Coagulation Profile in Pregnancy Induced Hypertension Cases”iosrjce
IOSR Journal of Biotechnology and Biochemistry (IOSR-JBB) covers studies of the chemical processes in living organisms, structure and function of cellular components such as proteins, carbohydrates, lipids, nucleic acids and other biomolecules, chemical properties of important biological molecules, like proteins, in particular the chemistry of enzyme-catalyzed reactions, genetic code (DNA, RNA), protein synthesis, cell membrane transport, and signal transduction. IOSR-JBB is privileged to focus on a wide range of biotechnology as well as high quality articles on genetic engineering, cell and tissue culture technologies, genetics, microbiology, molecular biology, biochemistry, embryology, cell biology, chemical engineering, bioprocess engineering, information technology, biorobotics.
Indications and Outcomes of Emergency Caesarean Section at St Paul’s Hospital...Crimsonpublishers-IGRWH
Indications and Outcomes of Emergency Caesarean Section at St Paul’s HospitalMedical College, Addis Ababa, Ethiopia 2017: (Afoul Month Retrospective Cohort Study) by Bizuneh Ayano in Womens Health Journal
A Comparative Study of Anthropometric Characteristics and Blood Pressure betw...ijtsrd
Background Hypertension is a frequently encountered multifactorial disorder and its prevalence is reported to increase in postmenopausal females. Cardiovascular disease is the leading cause of death in women. Furthermore, there is evidence that hormonal changes also leads to anthropometric changes associated with hypertension.Aim - To compare the anthropometric measures and blood pressure of pre and post menopausal women and find the association between anthropometric measures and hypertension.Methodology - A comparative study was conducted on 50 pre and 50 post menopausal women. The sampling method was purposive sampling and conducted in Goyala Vihar of Delhi. The door to door survey was conducted and data was collected using kobo tool. The measurements of BP, weight, height, hip and waist circumference was done following the protocols. The data was analysed using SPSS software.Result and conclusion - The result was significant for all variables Age, Wt, BMI, HC, WC, WHR and BAI except Ht. Independent T test was used to compare. Correlation and regression depicted that age is the predictor for diastolic blood pressure in pre menopausal women and for post menopausal women age, Ht, Wt, BMI, WC and HC are predictor of diastolic blood pressure. Women in post menopausal stage were at high risk of HTN compared to pre menopausal women. Jyoti Yadav "A Comparative Study of Anthropometric Characteristics and Blood Pressure between Pre and Post - Menopausal Women in Poor Urban Area, Goyala Vihar, Delhi" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-7 | Issue-4, August 2023, URL: https://www.ijtsrd.com/papers/ijtsrd59641.pdf Paper Url:https://www.ijtsrd.com/other-scientific-research-area/other/59641/a-comparative-study-of-anthropometric-characteristics-and-blood-pressure-between-pre-and-post---menopausal-women-in-poor-urban-area-goyala-vihar-delhi/jyoti-yadav
Indications and Outcomes of Emergency Caesarean Section at St Paul’s Hospital...Crimsonpublishers-IGRWH
Cesarean Section (CS) rates and their indications vary all over the World. Audit of indications and factors affecting infant and maternal outcome remain an important activity in rationalizing the use of this major procedure in obstetrics practice. Cesarean section (CS) carries a higher maternal morbidity and mortality compared to vaginal delivery. Noresearches have been done on this area.
A presentation by Mareike Körber at the 2017 meeting of the Scandinavian Society of Anaestesiology and Intensive Care Medicine.
All available content from SSAI2017: https://scanfoam.org/ssai2017/
Delivered in collaboration between scanFOAM, SSAI & SFAI.
Background: One of the most common disorders in this age group, abnormal uterine bleeding (AUB), is the primary cause of most gynaecological problems in adolescents. Unfortunately, epidemiological data on AUB in teenagers is scarce, especially in the Indian subcontinent. The PALM-COEIN classification, where PALM stands for structural reasons and COEIN for functional causes, was employed in this single-center prospective observational study to evaluate the relative contributions of several etiological factors in AUB. To comprehend the etiological, dermographic, and therapeutic factors affecting menorrhagia in patients going through adolescence. Methods: Enrollment for females with AUB between 10 and 19 occurred between January and December 2022. A thorough history, physical examination, and laboratory evaluation, which in every case comprised standard testing, hormone analysis, and abdominal and pelvic ultrasonography were used to determine the cause of AUB. MRIs and CT scans were performed when needed. Results: There were 190 patients enrolled in total. Functional factors comprised the predominant aetiology of AUB among adolescent females: Adenomyosis=01 (0.52%), Polyp=1 (0.52%). Coagulopathy=2 (1.05%), Leomyoma=01 (0.52%), Malignancy=1 (0.52%), and PALM=4 (2.11%). COEIN=186 (97.89%), ovulation disorder=175 (92.15%), endometrial=01 (0.52%), iatrogenic=6 (3.15%), non-specified=2 (1.05%), and iatrogenic=6 (3.15%). Conclusion: The most frequent cause of AUB in the adolescent population is ovulatory abnormalities. Even though they are extremely rare, structural factors must be ruled out. A helpful technique for evaluating patients with AUB systematically is the PALM-COEIN classification.
Key-words: PALM-COEIN, Leiomyoma, AUB, Polycystic ovarian syndrome, Hormonal therapy
Analysis of Epistaxis of Pregnancy and Association with Postpartum HemorrhageAI Publications
Epistaxis is a frequent condition that affects up to 70% of the general population at some point in their lives. A smaller percentage of people will experience recurring or habitual epistaxis during pregnancy, which is linked to postpartum hemorrhage. The goal of this study was to determine the prevalence of epistaxis among pregnant women and the relationship between it and postpartum hemorrhage. There was a statistically significant difference in the incidence of postpartum hemorrhage between patients with pregnancy epistaxis and patients without pregnancy epistaxis, according to the findings. Finally, the researchers found that though epistaxis is not a common complication during pregnancy, it does raise the risk of postpartum hemorrhage.
Uterine Artery Doppler and Prediction of PreeclampsiaAI Publications
The purpose of this study was to determine the accuracy of screening for pregnancy hypertension disorders using maternal serum biomarkers and uterine artery Doppler during the first trimester. At 11-13 weeks, uterine artery Doppler and serum measurements were taken from prospectively enrolled nulliparous women. In this study, maternal features, uterine artery Doppler imaging, and serum placental biomarkers (pregnancy-associated plasma protein-A, Inhibin-A, placental protein, A disintegrin and metalloprotease, free B-hCG, placental growth factor) were all collected and evaluated. Twenty women (2.2 percent) experienced prenatal hypertension, and forty women (4.5 percent) developed preeclampsia, with nine (1.0 percent) developing early-onset preeclampsia and sixteen (1.8 percent) developing severe preeclampsia, according to the findings. A combination screening model that included clinical features, pregnancy-associated plasma protein-A, Inhibin-A, and placental growth factor was found to be effective in detecting 75 percent of early-onset preeclampsia with a false-positive rate of 10 percent. Uterine artery Doppler, placental protein, A disintegrin and metalloprotease were all found to have no effect on diagnosis accuracy after adjusting for clinical factors. When combined with first-trimester maternal serum biomarkers (pregnancy-associated plasma protein-A, Inhibin-A, and placental growth factor), a combination of clinical features and placental growth factor can give an accurate screening for early-onset preeclampsia in nulliparous women.
Deep Leg Vein Thrombosis (DVT): Meaning, Causes, Symptoms, Treatment, and Mor...The Lifesciences Magazine
Deep Leg Vein Thrombosis occurs when a blood clot forms in one or more of the deep veins in the legs. These clots can impede blood flow, leading to severe complications.
Dr. David Greene R3 stem cell Breakthroughs: Stem Cell Therapy in CardiologyR3 Stem Cell
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About this webinar: This talk will introduce what cancer rehabilitation is, where it fits into the cancer trajectory, and who can benefit from it. In addition, the current landscape of cancer rehabilitation in Canada will be discussed and the need for advocacy to increase access to this essential component of cancer care.
LGBTQ+ Adults: Unique Opportunities and Inclusive Approaches to CareVITASAuthor
This webinar helps clinicians understand the unique healthcare needs of the LGBTQ+ community, primarily in relation to end-of-life care. Topics include social and cultural background and challenges, healthcare disparities, advanced care planning, and strategies for reaching the community and improving quality of care.
Stem Cell Solutions: Dr. David Greene's Path to Non-Surgical Cardiac CareDr. David Greene Arizona
Explore the groundbreaking work of Dr. David Greene, a pioneer in regenerative medicine, who is revolutionizing the field of cardiology through stem cell therapy in Arizona. This ppt delves into how Dr. Greene's innovative approach is providing non-surgical, effective treatments for heart disease, using the body's own cells to repair heart damage and improve patient outcomes. Learn about the science behind stem cell therapy, its benefits over traditional cardiac surgeries, and the promising future it holds for modern medicine. Join us as we uncover how Dr. Greene's commitment to stem cell research and therapy is setting new standards in healthcare and offering new hope to cardiac patients.
The best massage spa Ajman is Chandrima Spa Ajman, which was founded in 2023 and is exclusively for men 24 hours a day. As of right now, our parent firm has been providing massage services to over 50,000+ clients in Ajman for the past 10 years. It has about 8+ branches. This demonstrates that Chandrima Spa Ajman is among the most reasonably priced spas in Ajman and the ideal place to unwind and rejuvenate. We provide a wide range of Spa massage treatments, including Indian, Pakistani, Kerala, Malayali, and body-to-body massages. Numerous massage techniques are available, including deep tissue, Swedish, Thai, Russian, and hot stone massages. Our massage therapists produce genuinely unique treatments that generate a revitalized sense of inner serenely by fusing modern techniques, the cleanest natural substances, and traditional holistic therapists.
Cold Sores: Causes, Treatments, and Prevention Strategies | The Lifesciences ...The Lifesciences Magazine
Cold Sores, medically known as herpes labialis, are caused by the herpes simplex virus (HSV). HSV-1 is primarily responsible for cold sores, although HSV-2 can also contribute in some cases.
Gemma Wean- Nutritional solution for Artemiasmuskaan0008
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2. delivery and less than 1000 mL at cesarean delivery. Massive PPH was
defined as a minimum of 30% loss of blood volume at delivery. The infor-
mation was collected from the Maternity Electronic Information System
at St Georges Hospital, as approved by the hospital ethics committee.
Informed consent was not required because all patients received the
same care.
Baseline circulating blood volume was estimated to be 100 mL per
kilogram of body weight for all patients, using body weight measured
at the booking appointment prior to 12 weeks of pregnancy. The
OSI (pulse rate divided by systolic blood pressure) was calculated—
retrospectively—at 10 minutes and 30 minutes after the onset of post-
partum bleeding. Data were analyzed via Excel (Microsoft, Redmond,
WA, USA).
3. Results
Mean parity was 0.86 ± 2.64 in the case group and 0.64 ± 2.08 in
the control group. Mean booking weight was 64.02 ± 23.44 kg in the
case group and 69.06 ± 35.10 kg in the control group.
Mean blood loss in the control group was 417 mL (range,
200–1000 mL), compared with 2483 mL (range, 1500–5500 mL) in
the case group. Mean percentage loss of blood volume (i.e. estimated
blood loss divided by body weight in kilograms at prenatal booking
visit) was 39% (range, 30%–94%) in the case group.
Risk factors for PPH were more prevalent in the case group than in
the control group (Fig. 1). The cumulative total number of risk factors
present in the case group was 101, compared with 48 in the control
group. Cesarean delivery in the index pregnancy and assisted vaginal
delivery were associated with increased risk of massive PPH in the
study population. There was no significant difference in parity between
the 2 groups (Fig. 2); the majority of massive PPH cases involved
primiparous women.
In the control group, the mean OSI was 0.74 ± 0.30 (range, 0.4–1.1)
at 10 minutes and 0.76 ± 0.27 (range, 0.5–1.1) at 30 minutes (Fig. 3).
In the case group, the mean OSI was 0.91 ± 0.42 (range, 0.4–1.5) at
10 minutes and 0.90 ± 0.33 (range, 0.5–1.4) at 30 minutes (Fig. 4).
In total, 32 patients (64%) who experienced massive PPH required
blood transfusion (Fig. 5), of whom 4 required platelets and 14 also
required fresh frozen plasma. None of the patients in the control
group required blood or blood products.
In the case group, 89% (n = 8) of women with an OSI of 1.1 or
higher at 10 minutes required a blood transfusion; 75% (n = 6) of
women with an OSI of 1.1 or higher at 30 minutes required a blood
transfusion (Fig. 6). If the OSI was less than 1.1 at 10 minutes, the
chance of requiring a blood transfusion was 59% (n = 24); if the OSI
was less than 1.1 at 30 minutes, the chance of requiring a blood trans-
fusion was 62% (n = 26).
4. Discussion
Visual estimation of blood loss is fraught with the danger of un-
derestimation (or, rarely, overestimation), which can lead to delays
in diagnosing and treating ongoing massive PPH. This scenario of
“too little being done too late” can lead to serious maternal morbidity
and mortality, as highlighted by Confidential Enquiries into Maternal
Deaths [1].
In patients with normal blood loss at delivery, the mean OSI was
0.74 at 10 minutes. No individual value in this group was above 1.1.
Therefore, we propose that the normal OSI range should be 0.7–0.9,
compared with the reported range of 0.5–0.7 for the shock index in
non-pregnant populations. The increased observed value is probably
due to the normal physiological changes in the cardiovascular system
during pregnancy. At term, the pulse rate remains higher than in the
Fig. 1. Risk factors for postpartum hemorrhage (PPH). Abbreviations: IUD, intrauterine device; MROP, manual removal of placenta; PET, pre-eclamptic toxemia.
Fig. 2. Parity in the case and control groups. Abbreviation: PPH, postpartum hemorrhage.
Fig. 3. Obstetric shock index (OSI) for patients with no postpartum hemorrhage (control
group).
254 A. Le Bas et al. / International Journal of Gynecology and Obstetrics 124 (2014) 253–255
3. non-pregnant state, while the systolic blood pressure may have normal-
ized in the third trimester.
The mean OSI at 10 and 30 minutes was higher in the group with
massive PPH than in the control group. This was expected because the
shock index reflects hemodynamic stability and indicates that the OSI
might be a valuable marker of hemodynamic instability in cases of mas-
sive PPH. When the OSI was higher than the normal range (i.e. ≥1.1),
the use of blood products also increased, with an 89% chance of blood
transfusion when the OSI was higher than 1.1 at 10 minutes. This evi-
dence seems to support the usefulness of the OSI in not only identifying
significant blood loss in cases of massive PPH but also predicting
the need for blood and blood products. In order to simplify the use
of the OSI in an acute obstetric emergency, we propose that an OSI
higher than 1 (i.e. pulse rate N systolic blood pressure) is a marker for
clinical severity.
A limitation of the OSI is its use in cases of pre-eclampsia because
resting systolic blood pressure would be elevated and, therefore,
might produce a falsely reassuring OSI. The use of the OSI in clinical
practice is based on a normal physiological response to hypovolemia,
and thus should always be considered in clinical context. A limitation
of the present study was that blood transfusion or fluid resuscitation oc-
curred within 30 minutes for some patients in the dataset. Therefore,
the OSI values could have been lower in these cases owing to correction
of hemodynamic parameters, which may have influenced the results.
Indeed, some patients may compensate well for large blood loss without
significant changes in their heart rate or systolic blood pressure. There-
fore, clinicians need to interpret OSI values with caution after intensive
resuscitation because they may not reflect the actual blood loss. We
attempted to reduce the potential for error by calculating the OSI at
both 10 and 30 minutes after massive PPH.
It is routine practice in the UK to assess patient weight at booking
but not thereafter unless specifically indicated. Therefore, the original
booking weight was used in the calculation of blood volume. Although
changes in weight occur throughout pregnancy, which could have
affected the calculations, similar changes should have occurred in the
case and the control groups, so the effect should have been balanced.
The effectiveness of the OSI based on booking weight means that it
can easily be applied in current practice.
Prompt recognition of hemodynamic instability in cases of massive
PPH enables timely and appropriate treatment to improve outcomes
and save lives [8,9]. The OSI is of value in raising suspicion when it is
outside the normal range, even when heart rate and blood pressure
are not. The decision to carry out blood transfusion should be based
on clinical parameters and, based on the present pilot study, we recom-
mend the use of an OSI value higher than 1 as an additional assessment
tool for significant blood loss, as well as a simple marker (i.e. pulse
rate N systolic blood pressure) to predict the need for blood and blood
products. Although further research is required to validate this, based
on experience from management of major trauma, an OSI value higher
than 1 seems to be clinically useful in the obstetric population.
Conflict of interest
The authors have no conflicts of interest.
References
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Fig. 5. Blood product usage in cases of massive postpartum hemorrhage. Abbreviation:
FFP, fresh frozen plasma.
Fig. 6. Percentage of patients with massive postpartum hemorrhage who underwent
transfusion in relation to obstetric shock index (OSI).
Fig. 4. Obstetric shock index (OSI) for patients with massive postpartum hemorrhage
(case group).
255A. Le Bas et al. / International Journal of Gynecology and Obstetrics 124 (2014) 253–255