Correlation between shock index and diastolic blood pressure in patients with postpartum hemorrhage and early warning of postpartum hemorrhage risk: an analysis of numerous cases in 4 years / 中华危重病急救医学

ABSTRACT

Objective To observe the changes of shock index (SI) and diastolic blood pressure (DBP) in postpartum hemorrhage patients, and the explore their relationship with postpartum hemorrhage and the clinical significance of early warning of hemorrhage risk. Methods 402 patients with postpartum hemorrhage (within 24 hours after delivery, the amount of bleeding in vaginal delivery≥500 mL, and the amount of bleeding in caesarean delivery≥1 000 mL) admitted to the obstetrics ward of Affiliated Hospital of Hangzhou Normal University from January 2014 to December 2017 were selected as the objective group and 416 without complications during delivery were selected as the control group in the same hospital at the same period. Clinical data in the two groups before and after childbirth was collected, including age, pregnancy week, 24-hour blood loss, and hemoglobin (Hb), whole blood cell parameters, heart rate (HR), systolic blood pressure (SBP), DBP, SI, blood urea nitrogen (BUN), serum creatinine (SCr) within 24 hours before and after delivery, and postpartum 24 hours and prenatal DBP difference (&Delta;DBP). The differences of indicators were compared between the two groups. Pearson method was used to analyze the correlation between the postpartum DBP and SI in the objective group. Ordinal regression model was used to analyze the early warning risk factors of each index to postpartum hemorrhage. Results Compared with the control group, older age (years 29.29±5.01 vs. 28.05±4.46), more pregnancies (times 2.68±1.42 vs. 2.33±1.28), shorter gestation weeks (weeks 38.33±3.57 vs. 39.05±1.40), more 24-hour blood loss (mL 726.57±467.66 vs. 244.49±50.25) in the objective group were significant differences (all P﹤0.01). Postpartum hemorrhage patients were successfully hemostatic, no maternal and perinatal death was found in the two groups. Compared with the control group, DBP was significantly decreased at 24 hours after delivery in the objective group [mmHg (1 mmHg = 0.133 kPa) 71.19±12.55 vs. 75.68±8.96, P < 0.05], and &Delta;DBP was significantly increased (mmHg 5.39±3.93 vs. 0.67±0.33, P < 0.01). In addition, compared with the control group, SI and HR were significantly increased in the objective group [SI0.80±0.15 vs. 0.72±0.11, HR (bpm) 91.56±13.37 vs. 82.96±11.76, both P < 0.05], Hb, red blood cell count (RBC), platelet count (PLT) and SBP were significantly decreased [Hb (g/L) 91.30±13.41 vs. 112.30±13.41, RBC (×1012/L) 3.74±0.38 vs. 4.59±0.45, PLT (×109/L) 173.02±59.08 vs. 182.09±54.76, SBP (mmHg)115.13±9.27 vs. 117.94±11.66, all P﹤0.05]. Correlation analysis showed that postpartum DBP was negatively correlated with SI, 24-hour blood loss, &Delta;DBP, BUN and SCr (r value was -0.419, -0.268, -0.490, -0.108, -0.163, respectively, all P < 0.05), and positively correlated with SBP, Hb and RBC (r value was 0.739, 0.125, 0.096, respectively, all P < 0.05). It was shown by Ordinal regression analysis that the risk of postpartum hemorrhage was significantly increased when &Delta;DBP≥9.32 mmHg [relative risk (RR) = 2.64, 95% confidence interval (95%CI) =1.94-3.34, P = 0.000], SI≥0.95 (RR = 1.78, 95%CI = 1.01-2.55, P = 0.000), DBP≤59.64 mmHg (RR = 0.86, 95%CI = 0.31-1.41, P = 0.000), SBP≤105.86 mmHg (RR = 0.63, 95%CI = 0.18-1.07, P = 0.000), Hb≤77.89 g/L (RR = 1.68, 95%CI = 0.99-2.38, P = 0.000), and &Delta;DBP≥9.32 mmHg was the most effective early warning effect. Conclusions Combined with clinical manifestations of patients with postpartum hemorrhage, SI and DBP can be used as an important reference indicator for the observation of postpartum hemorrhage conditions. &Delta;DBP≥9.32 mmHg can be used as the risk factors of the patient with postpartum hemorrhage.