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Diagnostic performance of serial bedside Capillary Hemoglobin, Lactate and Shock index for severe postpartum hemorrhage. A Prospective Cohort Study.
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  • Roberto Castillo Reyther,
  • Idelia Plata Alcocer ,
  • Salvador De la Maza Labastida,
  • Ma. del Pilar Leal Fonseca,
  • Venance Kway
Roberto Castillo Reyther
Hospital Central Dr. Ignacio Morones Prieto
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Idelia Plata Alcocer
Hospital Central Dr. Ignacio Morones Prieto, San Luis Potosi, Mexico
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Salvador De la Maza Labastida
Hospital Central Dr. Ignacio Morones Prieto
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Ma. del Pilar Leal Fonseca
Universidad Autonoma de San Luis Potosi Mexico
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Venance Kway
Hospital Central Dr. Ignacio Morones Prieto, San Luis Potosi, Mexico

Corresponding Author:[email protected]

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Abstract

Objective: To evaluate the diagnostic capacity of bedside capillary lactate (CLact), capillary Hemoglobin (CHb), and Shock index (SI) for severe postpartum haemorrhage (SPPH), at diagnosis 15 minutes and 30 minutes post-diagnosis Design: A prospective cohort study. Setting: A reference hospital in San Luis Potosi Mexico from February 2020 to March 2021 Population: Sixty women in vaginal labour or c-section who presented bleeding ≥500ml Methods: SI, CLact, and CHb concentration were analyzed at diagnosis, 15 minutes, and 30 minutes time intervals. T-test or Wilcox test was used to compare the group of severe vs non-severe. A Receiver Operating Curve was done to determine their cut points, Sensitivity, specificity, and performance Main Outcome Measures: SPPH defined as bleeding ≥2000ml measured by gravimetric method. Results SI at the diagnosis was significantly differentiate between severe from non-severe group (0.70 + 0.20 vs 0.90 + 0.38 P-value 0.0228) with al cut-point of 1.17 AUC of 0.76 sensitivity of 0.43 and specificity of 0.98. A capillary lactate measurement at 30 minutes was also significantly different between the groups (4.0 +1.90 vs 4.8 + 1.15 P-value < 0.001, with an optimal cut point of 4.3 mmol/dl at AUC 0.75, sensitivity 0.85, and specificity of 0.62. Capillary haemoglobin was not able to significantly differentiate the groups Conclusions: Shock index is an early sign of severe haemorrhage; Capillary lactate can significantly identify severe haemorrhage after 30 min. Capillary haemoglobin is not an early detector of severe haemorrhage.