Shock Index In Obstetric Hemorrhage As An Applicable Method To Anticipate Adverse Outcome

Background: To establish the ability of shock index and the different vital signs to predict the adverse maternal outcomes in the cases of obstetric hemorrhage . Methods: This prospective - retrospective study comprised patients with primary PPH or hemorrhage due to obstetric cause who were referred to zagazig University hospital Egypt , from January 2018, to December 2019 Data of vital signs of them ; systolic and diastolic blood pressure, pulse rate, pulse pressure, mean arterial pressure and shock index (heart rate divided by systolic blood pressure) at time of arrival were investigated . Adverse outcome like ,death , admission to the intensive care unit , massive transfusion and invasive procedures were revised and analyzed. AUROC (area under the receiver operating characteristic curve ) was used for shock index in comparison to each vital sign for predicting the adverse maternal outcomes. Sensitivity, specificity, and negative and positive predictive values were assessed to detect the best predictor.Results: The mean age of participants years (SD)was 29.2 ( ±7.3) of admission and 44% had altered. The most Common cause of hemorrhage was Iatrogenic ; either misuse of uterotonic or traumatic 30.2% The mean value of HR 108.1±26.6 , SBP 101± 28.7 mmHg , DBP 58.9±21.3 mmHg , SI 1.153±0.541 and mean blood loss 1922 (0.862) .For death, SI and SBP had the highest AUC value at 0.88 (0.81–0.95) with P=0.213). For ICU blood transfusion ≥ 5iu , admission and invasive surgical interventions, SI had the uppermost AUROC value at 0.76, 0.78 and 0.61. Sensitivity for all adverse outcomes of SI ≥ 0.7,is h from 99 to 90.0 . For death prediction SI≥ 0.7 had very low specificity ;0.6{0.2-1.3}and of SI ≥ 0.9 ;6.4{2.8-7.1}Conclusion: Shock index is a strapping applicable predictor of adverse outcomes. for patients who suffering from hypovolemic shock due to obstetric hemorrhage,

Tendencia actual de la mortalidad materna. Maternidad “Concepción Palacios” 2014-2020

Objective: To analyze maternal mortality in the Maternidad “Concepción Palacios” Hospital between January 2014 and December 2020. Methods: A descriptive, analytical, and retrospective study of maternal deaths occurred in the 2013-2018 period was carried out. Results: There were 73 maternal deaths, and a ratio of 135.96 per 100,000 live births. Direct maternal deaths were 60, 82.19% of the population and 13 indirect maternal deaths, 17.80%. The causes of direct maternal death were hypertensive disorders of pregnancy 48.33%, sepsis 26.66%, and obstetric hemorrhage 23.33%, with a 1: 3 ratios of maternal deaths at extreme ages of reproductive life. Conclusions: The maternal death ratio in the Maternidad “Concepción Palacios” Hospital duplicates the goals of the sustainable development goals of the 2016-2030 agenda; there is an increase in hypertensive disorders of pregnancy as a direct cause of maternal mortality. Primiparity, the absence or lack of data from prenatal control, cesarean sections, and admission-death time of less than 24 hours prevailed. Recommendations: Advances are needed in sexual and reproductive health education, education and training of health personnel in extreme maternal morbidity, analysis by theoretical premises identifying the social determinants of maternal mortality and the health reality related to its management, implementing preventive public policies with specific care guidelines. Keywords: Maternal mortality, Hypertensive disorders of pregnancy, Maternal sepsis, Obstetric hemorrhage.

Maternal morbidity of adolescent pregnant women

Background: In Mexico, it is estimated that the adolescent population represents 29% of the population of childbearing age. The present study aimed to analyze the obstetric results of 3310 adolescent pregnant women attended in a third level hospital. Material and methods: All records of pregnant women aged 19 years or less up to the date of admission were analyzed at the Mónica Pretelini Saenz Maternal Perinatal Hospital during the period from January 2018 to June 2020, with the following variables: age, pregnancy, resolution obstetric, severe preeclampsia, preeclampsia and gestational hypertension. Results: A total of 13874 pregnant women were attended, of which 3310 (24%) patients were adolescents. The overall frequency of obstetric complications was 21%, including obstetric hemorrhage (13%) and hypertensive disorders of pregnancy (8%). Regarding postpartum obstetric hemorrhage events, classified according to the Advanced Trauma Life Support shock scale, they were categorized as Grade 1 – 338 cases, Grade II – 76 cases, Grade III – 11 cases and Grade IV – 1 case. Hypertensive disorders of pregnancy highlight preeclampsia as the most frequent with a total of 97 cases, followed by 89 cases of severe preeclampsia, 58 cases of gestational hypertension, 14 cases of chronic hypertension and 3 cases of chronic hypertension with preeclampsia. Conclusions: The main complications found in the Mexican pregnant adolescent population were obstetric hemorrhage, which was more frequent in the population aged 15 to 19 years, and hypertensive disorders, which occurred more frequently in the population aged 9 to 14 years.

Serum Lactate Level as a Predictor for Blood Transfusion in Postpartum Hemorrhage

Objective Postpartum hemorrhage (PPH) is the leading cause of maternal morbidity and mortality. At present, there are no reliable clinical or laboratory indicators to identify which patients might require blood transfusions during a PPH. Serum lactate has long been used as an early biomarker of tissue hypoperfusion in trauma settings. The aim of this study is to understand serum lactate's role in the management of obstetric hemorrhage. Study Design A retrospective chart review was performed of women who delivered between 2016 and 2019 at our institution and experienced a PPH. The patients were divided into two groups: those with a normal serum lactate level, defined as ≤2 mmol/L, and those with an abnormal serum lactate level, defined as >2 mmol/L. Need for packed red blood cell transfusion, as part of the resuscitation, was assessed for both groups. Results During the study period, 938 women experienced PPH. Of these, 108 (11.5%) had a normal serum lactate, ≤2 mmol/L, and 830 (88.5%) had an abnormal lactate, >2 mmol/L. Women with elevated lactate levels were more likely to receive a blood transfusion versus those with a normal lactate level (57.0 vs. 46.3%, p = 0.035, respectively). Additionally, the average number of blood transfusions administered was significantly higher in the abnormal lactate group versus in the normal lactate group (1.34 vs. 0.97, respectively, p = 0.004). In a multivariable linear regression model, increasing serum lactate levels were found to be predictive of requiring more than 1 unit of blood (p < 0.001). Conclusion Women with elevated serum lactate levels were more likely to require blood transfusions during a PPH versus those with a normal serum lactate level. Thus, serum lactate levels are useful as an early indicator of requirement for blood transfusion in the management of obstetric hemorrhage. Key Points

Resurgence of classical caesarean section in current obstetric practice- A case series

Although, the incidence of placenta accreta spectrum (PAS) and large fibroids is rare but still these cases contributes to a large number of maternal morbidity and mortality. Major obstetric hemorrhage is one the dreadful complication of these types of cases and thus early diagnosis and intervention in such cases helps the physician to minimize the risk to mother and the fetus. Also, current widespread use of ultrasound has helped us to manage these cases judiciously, predict and prevent life threatening obstetric hemorrhage. Here we present three complicated obstetric cases of placenta accreta, large lower segment uterine fibroid and large cervical fibroid which necessitated classical cesarean sections (CCS) thus emphasizing prowess in CCS in modern obstetric era. High index of suspicion, Multidisciplinary approach alongwith expert surgical personnel should be available in high risks cases like placenta accreta syndrome and large fibroids in pregnancy.