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)