Introduction
Postpartum haemorrhage is the leading cause of maternal mortality and
morbidity in the world accounting for approximately 10% of all births
and the most common form of obstetric haemorrhage, which traditionally
has been defined as a blood loss greater than 500 ml after vaginal
delivery or 1,000 ml after cesarean section.(1) In 2017 the American
College of Gynecology and Obstetrics (ACOG) published a recent
definition as a cumulative blood loss greater than or equal to 1,000 ml
or a blood loss accompanied by signs or symptoms of hypovolemia within
24 hours of the delivery regardless of the route of birth. (1) Some
institution still considers the traditional definition as appropriate.
(2) In Mexico, obstetric haemorrhage continues to be one of the main
causes of extremely serious maternal mortality and morbidity especially
in a low-resourced facility due to failure to identify the causes and
lack of timely and adequate treatment. One of the main problems during
the medical management of these cases is the early identification of
patients with severe cases o may develop severe haemorrhage and may need
immediate resuscitation and need for blood products. (3). Currently,
there are multiple criteria to initiate blood transfusion and fluid
reanimation, basically, the decision includes clinical and biochemical
evaluation, however, clinical changes in vital signs may appear late.
According to major clinical guidelines, one of the transfusion criteria
is blood loss of more than 1500 to 2000 ml but the blood loss
quantification is still a problem. (4–7). Serum lactate and shock index
have shown to be a good and early predictor of complications and
necessity for transfusion, but in most of the low resourced facilities,
it may be difficult to timely get it realized (8–10). Understanding the
need for reliable bedside clinical tools to identify patients at risk of
reaching a critical condition if they are not provided immediate
resuscitation we investigated the use of bedside and minimally invasive
protocol by measuring capillary lactate and haemoglobin with Acuttrend®
Lactate and HemoCue® respectively. As a point of care that allows a
quick dynamic evaluation accompanied by a clinical marker, we integrated
the shock index (SI), which has also shown a better prediction towards
adverse outcomes in patients with obstetric haemorrhage than
conventional vital signs (11)