SynthesisPloS one2013
A systematic review of the relationship between blood loss and clinical signs.
Synthesis in PloS one, 2013. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. Cited by 69 papers, 7 of them syntheses that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
69 citing papers in PubMed, 7 syntheses or guidelines pooled it, 213 citations in OpenAlex.
- FIGO recommendations on objective measurement of blood loss after birth for early detection of postpartum hemorrhage.International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics · 2025Guideline
- Quantification of blood loss for the diagnosis of postpartum hemorrhage: a systematic review and meta-analysis.Revista brasileira de enfermagem · 2023Pooled it
- Shock index as a predictor for mortality in trauma patients: a systematic review and meta-analysis.European journal of trauma and emergency surgery : official publication of the European Trauma Society · 2022Pooled it
- Assessing Fluid Resuscitation in Adults with Sepsis Who Are Not Mechanically Ventilated: a Systematic Review of Diagnostic Test Accuracy Studies.Journal of general internal medicine · 2019Pooled it
- A systematic review of large animal models of combined traumatic brain injury and hemorrhagic shock.Neuroscience and biobehavioral reviews · 2019Pooled it
- Methods for blood loss estimation after vaginal birth.The Cochrane database of systematic reviews · 2018Pooled it
- The prevalence of women's emotional and physical health problems following a postpartum haemorrhage: a systematic review.BMC pregnancy and childbirth · 2016Pooled it
- When are postpartum haemorrhages diagnosed? A nested observational study within the E-MOTIVE cluster-randomised trial.The Lancet. Global health · 2025Trial
- Suspension syndrome: a potentially fatal vagally mediated circulatory collapse-an experimental randomized crossover trial.European journal of applied physiology · 2019Trial
- Evaluation of postpartum anaemia screening to improve anaemia diagnosis and patient care: A prospective non-randomized before-and-after anaemia screening protocol implementation study.Scientific reports · 2019Trial
- Trial
- Shock index and heart rate standard reference values in the immediate postpartum period: A cohort study.PloS one · 2019Trial
- Development and validation of a clinical prediction model for postpartum hemorrhage after elective cesarean section.Journal of anesthesia · 2026Observational
- Prevalence, characteristics, and outcomes of postpartum hemorrhage in a tertiary hospital in Tigray, Northern Ethiopia (2017-2021): retrospective descriptive study.BMC pregnancy and childbirth · 2026Article
- PAD Score: A Clinical Prediction Tool for Disseminated Intravascular Coagulation in Placental Abruption.Journal of clinical medicine · 2026Article
- Early detection of hypovolemia by venous pulse wave velocity and vena cava ultrasound imaging.European journal of applied physiology · 2026Article
- Evaluating shock index for prediction of adverse maternal outcomes related to postpartum haemorrhage and maternal sepsis in Sierra Leone: a prospective observational cohort study.EClinicalMedicine · 2025Article
- A prospective, observational study of non-invasive venous waveform analysis (NIVA) for the detection of acute low volume blood loss in humans.Journal of clinical anesthesia · 2025Observational
- Clinical Assessment of Fluid Status in Adults With Acute Kidney Injury: A Scoping Review.Journal of renal care · 2025Article
- Postpartum Hemorrhage.Maternal-fetal medicine (Wolters Kluwer Health, Inc.) · 2025Review
9 more citing papers are in PubMed but not listed here.
Corrections and comments
- Erratum issued
Authors and funding
7 authors at 4 institutions in 4 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
introductionThis systematic review examines the relationship between blood loss and clinical signs and explores its use to trigger clinical interventions in the management of obstetric haemorrhage.
methodsA systematic review of the literature was carried out using a comprehensive search strategy to identify studies presenting data on the relationship of clinical signs & symptoms and blood loss. Methodological quality was assessed using the STROBE checklist and the general guidelines of MOOSE.
results30 studies were included and five were performed in women with pregnancy-related haemorrhage (other studies were carried in non-obstetric populations). Heart rate (HR), systolic blood pressure (SBP) and shock index were the parameters most frequently studied. An association between blood loss and HR changes was observed in 22 out of 24 studies, and between blood loss and SBP was observed in 17 out of 23 studies. An association was found in all papers reporting on the relationship of shock index and blood loss. Seven studies have used Receiver Operating Characteristic Curves to determine the accuracy of clinical signs in predicting blood loss. In those studies the AUC ranged from 0.56 to 0.74 for HR, from 0.56 to 0.79 for SBP and from 0.77 to 0.84 for shock index. In some studies, HR, SBP and shock index were associated with increased mortality.
conclusionWe found a substantial variability in the relationship between blood loss and clinical signs, making it difficult to establish specific cut-off points for clinical signs that could be used as triggers for clinical interventions. However, the shock index can be an accurate indicator of compensatory changes in the cardiovascular system due to blood loss. Considering that most of the evidence included in this systematic review is derived from studies in non-obstetric populations, further research on the use of the shock index in obstetric populations is needed.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.