Postpartum hemorrhage: new insights for definition and diagnosis

A Borovac-Pinheiro; R C Pacagnella; J G Cecatti; S Miller; A M El Ayadi; J P Souza; J Durocher; P D Blumenthal; B Winikoff

doi:10.1016/j.ajog.2018.04.013

Postpartum hemorrhage: new insights for definition and diagnosis

Am J Obstet Gynecol. 2018 Aug;219(2):162-168. doi: 10.1016/j.ajog.2018.04.013. Epub 2018 Apr 14.

Authors

A Borovac-Pinheiro¹, R C Pacagnella², J G Cecatti¹, S Miller³, A M El Ayadi³, J P Souza⁴, J Durocher⁵, P D Blumenthal⁶, B Winikoff⁵

Affiliations

¹ Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas, Campinas, Brazil.
² Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas, Campinas, Brazil. Electronic address: rodolfopacagnella@gmail.com.
³ Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, CA.
⁴ Department of Social Medicine, School of Medicine of Ribeirão Preto, University of São Paulo, Ribeirao Preto, Brazil.
⁵ Gynuity Health Projects, New York, NY.
⁶ Stanford University School of Medicine, Department of Obstetrics and Gynecology, Division of Family Planning Services and Research, Stanford University, Stanford, CA.

PMID: 29660298
DOI: 10.1016/j.ajog.2018.04.013

Abstract

The current definition of is inadequate for early recognition of this important cause of maternal death that is responsible for >80,000 deaths worldwide in 2015. A stronger definition of postpartum hemorrhage should include both blood loss and clinical signs of cardiovascular changes after delivery, which would help providers to identify postpartum hemorrhage more promptly and accurately. Along with the amount of blood loss, clinical signs, and specifically the shock index (heart rate divided by systolic blood pressure) appear to aid in more accurate diagnosis of postpartum hemorrhage.

Keywords: clinical sign; definition; postpartum hemorrhage; shock index.

MeSH terms

Blood Pressure
Early Diagnosis
Female
Heart Rate
Humans
Maternal Mortality
Postpartum Hemorrhage / diagnosis*
Postpartum Hemorrhage / mortality
Postpartum Hemorrhage / physiopathology
Pregnancy
Severity of Illness Index
Shock / diagnosis*
Shock / mortality
Shock / physiopathology
Systole