2016 Volume 4 Issue 2 Pages 88-96
Aim: To evaluate whether there are any women with postpartum hemorrhage (PPH) showing a hemoglobin (Hb) concentration of <7.0 g/dl in cases with estimated blood loss of <1,500 ml or a shock index (SI) of >1.5 in cases with estimated blood loss of <2,500 ml.
Methods: We reviewed the records of 36 women transferred due to PPH in our tertiary center in 2002-2005. We collected the patients’ information including the estimated blood loss, Hb concentration, and SI on arrival.
Results: In the group of 500–1,499 ml, 13% (2/16) showed Hb concentrations of <7.0 g/dl. In the group of 1,500–2,499 ml, one woman with uterine inversion whose estimated blood loss was 1,600 ml showed SI of 1.9 with a Hb concentration of 6.3 g/dl. SI in women with uterine inversion was significantly higher than in those with atonic bleeding, retention of placenta/accreta, and vaginal/cervical lacerations, respectively. SI in all women with uterine inversion was >1.0, although in three quarters of the cases, the blood loss was reported as <2,500 ml.
Conclusions: Our chart review clearly demonstrates that there are some PPH cases showing mismatch between the reported estimated blood loss and the Hb concentration and/or SI. Especially, SI may be clinically useful for judging transfusion in women with uterine inversion. We should identify the factors in such mismatching cases, and reveal the pitfalls of the current guideline for critical obstetrical hemorrhage mainly based on SI.
