ABSTRACT.
Objective: To evaluate the diagnostic capacity of bedside
capillary lactate (CLact), capillary Hemoglobin (CHb), and Shock index
(SI) for severe postpartum haemorrhage (SPPH), at diagnosis 15 minutes
and 30 minutes post-diagnosis
Design: A prospective cohort study.
Setting: A reference hospital in San Luis Potosi Mexico from
February 2020 to March 2021
Population : Sixty women in vaginal labour or c-section who
presented bleeding ≥500ml
Methods: SI, CLact, and CHb concentration were analyzed at
diagnosis, 15 minutes, and 30 minutes time intervals. T-test or Wilcox
test was used to compare the group of severe vs non-severe. A Receiver
Operating Curve was done to determine their cut points, Sensitivity,
specificity, and performance
Main Outcome Measures: SPPH defined as bleeding ≥2000ml
measured by gravimetric method.
Results SI at the diagnosis was significantly differentiate
between severe from non-severe group (0.70 + 0.20 vs 0.90+ 0.38 P-value 0.0228) with al cut-point of 1.17 AUC of 0.76
sensitivity of 0.43 and specificity of 0.98. A capillary lactate
measurement at 30 minutes was also significantly different between the
groups (4.0 + 1.90 vs 4.8 + 1.15 P-value < 0.001,
with an optimal cut point of 4.3 mmol/dl at AUC 0.75, sensitivity 0.85,
and specificity of 0.62. Capillary haemoglobin was not able to
significantly differentiate the groups
Conclusions: Shock index is an early sign of severe
haemorrhage; Capillary lactate can significantly identify severe
haemorrhage after 30 min. Capillary haemoglobin is not an early detector
of severe haemorrhage.