ArticleActa obstetricia et gynecologica Scandinavica2019
Shock index thresholds to predict adverse outcomes in maternal hemorrhage and sepsis: A prospective cohort study.
Article in Acta obstetricia et gynecologica Scandinavica, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 21 papers.
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21 citing papers in PubMed, 52 citations in OpenAlex.
- Comparison of the Effects of Dill Seed, Grape Seed and Date Extracts on Postpartum Hemorrhage Rates in the Fourth Stage of Labor: A Randomized Clinical Trial.Reviews on recent clinical trials · 2025Trial
- Effect of the CRADLE vital signs alert device intervention on referrals for obstetric haemorrhage in low-middle income countries: a secondary analysis of a stepped- wedge cluster-randomised control trial.BMC pregnancy and childbirth · 2021Trial
- Assessment of point-of-care creatinine testing in pregnancy: a prospective cohort study in Sierra Leone.The Lancet regional health. Africa · 2026Article
- Association of Pre-Spinal Shock Indices and Right Internal Jugular Vein Collapsibility Index with Post-Spinal Hypotension During Cesarean Delivery: A Prospective Observational Study.Journal of clinical medicine · 2026Article
- Impact of Contrast-Enhanced Computed Tomography on the Management of Postpartum Hemorrhage with Extravasation.Journal of clinical medicine · 2026Article
- Evolving perspectives on blood transfusion in obstetric hemorrhage: a narrative review.Korean journal of anesthesiology · 2026Review
- Strategies to improve outcomes of obstetric emergencies in sub-Saharan Africa: A scoping review.PloS one · 2026Article
- Evaluation of model performance in predicting sepsis after intestinal obstruction surgery: a multicenter retrospective study.Annals of medicine · 2025Article
- 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
- Postpartum Haemorrhage and Long-Term Mortality.Paediatric and perinatal epidemiology · 2025Article
- Association between preoperative shock index and hypotension after spinal anesthesia for non-elective cesarean section: a prospective cohort study.BMC anesthesiology · 2024Observational
- Prenatal hypertension as the risk of eclampsia, HELLP syndrome, and critical obstetric hemorrhage.Hypertension research : official journal of the Japanese Society of Hypertension · 2024Article
- Abnormal obstetric shock index and associated factors among immediate postpartum women following vaginal delivery at a tertiary hospital in southwestern Uganda.BMC pregnancy and childbirth · 2024Article
- How Learning from Trauma Benefits the Obstetric Population? Damage Control Surgery.Maternal-fetal medicine (Wolters Kluwer Health, Inc.) · 2023Article
- Effects of growth trajectory of shock index within 24 h on the prognosis of patients with sepsis.Frontiers in medicine · 2022Article
- Equivalency between the shock index and subtracting the systolic blood pressure from the heart rate: an observational cohort study.BMC emergency medicine · 2020Observational
- Shock Index in the Prediction of Adverse Maternal Outcome.Journal of obstetrics and gynaecology of India · 2020Article
- How to close the maternal and neonatal sepsis gap in sub-Saharan Africa.BMJ global health · 2020Article
- Sepsis: Precision-Based Medicine for Pregnancy and the Puerperium.International journal of molecular sciences · 2019Review
- Shock index thresholds to predict adverse outcomes in maternal hemorrhage and sepsis: A prospective cohort study.Acta obstetricia et gynecologica Scandinavica · 2019Article
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Authors and funding
10 authors at 3 institutions in 2 countries.
Funding
Abstract
introductionShock index (SI) is a predictor of hemodynamic compromise in obstetric patients. The SI threshold for action is not well understood. We aimed to evaluate SI thresholds as predictors of outcomes in obstetric patients. MATERIAL AND
methodsWe undertook a prospective cohort study at three South African hospitals of women with postpartum hemorrhage (n = 283) or maternal sepsis (n = 126). The "first" and "worst" SI following diagnosis were recorded. SI was compared with conventional vital signs as predictors of outcomes. The performance of SI <.9, SI .9-1.69 and SI ≥1.7 to predict outcomes (maternal death; Critical Care Unit admission; major procedure; hysterectomy) and hemorrhage-specific outcomes (lowest hemoglobin <70 g/l; blood transfusion ≥4 IU) were evaluated.
results"First" SI was one of two best performing vital signs for every outcome in postpartum hemorrhage and sepsis. In hemorrhage, risk of all outcomes increased with increasing "first" SI; for blood transfusion ≥4 IU odds ratio was 4.24 (95% confidence interval 1.25-14.36) for SI ≥1.7 vs SI .9-1.69. In sepsis, risk of all outcomes increased with increasing "worst" SI. Sensitivity, specificity, positive and negative predictive values of "first" SI <.9 vs SI ≥.9 for maternal death were 100.0%, 55.2%, 4.6% and 100.0%, respectively, in hemorrhage and 80.0%, 50.4%, 12.3% and 96.7%, respectively, in sepsis.
conclusionsThe shock index was a consistent predictor of outcomes compared with conventional vital signs in postpartum hemorrhage and sepsis. SI <.9 performed well as a rule-out test and SI .9-1.69 and SI ≥1.7 indicated increased risk of all outcomes in both cohorts. These thresholds may alert to the need for urgent intervention and prevent maternal deaths.
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