Evaluating Shock Index Trajectories for Improving Management of Obstetric Hemorrhage

Investigator: Alison El Ayadi, ScD, MPH
Sponsor: UCSF Resource Allocation Program (RAP)

Location(s): Zambia; Zimbabwe; Egypt; Nigeria




The majority of Postpartum Hemorrhage (PPH) occurs without warning; thus, consistent implementation of prevention measures, rapid PPH recognition and prompt identification and treatment of hemorrhage etiology are essential to reduce maternal mortality and morbidity. Frequent monitoring of vital signs and palpation of the uterine fundus after delivery is recommended to identify PPH development, and providers should remain cognizant of blood loss and vital signs. Timely recognition of PPH through accurate monitoring of blood loss at delivery and postpartum is critical in resource-poor settings, but is also useful in the developed world. The shock index, a combined measure of pulse and systolic blood pressure (pulse/systolic bp), was found to have clinical utility for earlier identification of adverse outcome in trauma. Further research among the obstetric population is necessary to understand whether shock index is a superior indicator of obstetric hemorrhage than traditional vital signs, and to understand how shock index responds in the context of treatment.