Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas - UNICAMP, Campinas, Brazil.
Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas - UNICAMP, Campinas, Brazil.
Best Pract Res Clin Obstet Gynaecol. 2019 Nov;61:89-105. doi: 10.1016/j.bpobgyn.2019.05.012. Epub 2019 May 27.
The major cause of maternal death worldwide is postpartum hemorrhage (PPH). Early identification is the basis for adequate treatment. In addition to the visual estimation of blood loss, clinical signs could offer a more reliable representation of the cardiovascular system of the bleeding woman. However, in postpartum women, recognition of hypovolemic shock through vital signs is impaired owing to physiological cardiovascular changes in pregnancy. The Shock Index [SI] is one composite vital sign that may help in the identification of women with hypovolemic shock. Values of SI ≥ 1 in the first hour postpartum indicate cardiac decompensation, and treatment should be implemented immediately. From the diagnosis of PPH, first-line measures should ensure coordinated care actions including the availability of blood derivatives, the establishment of conditions for volume replacement, oxygen therapy, and identification and timely treatment causes of bleeding. Individualized fluid resuscitation should start with warmed crystalloids and be limited to 3.5 L.
全球孕产妇死亡的主要原因是产后出血（PPH）。早期识别是充分治疗的基础。除了对出血量的目测估计外，临床体征可以更可靠地反映出血妇女的心血管系统状况。然而，在产后妇女中，由于妊娠期间心血管的生理性变化，通过生命体征识别低血容量性休克的能力受损。休克指数（SI）是一种综合生命体征，可能有助于识别低血容量性休克的妇女。产后 1 小时内 SI 值≥1 表明心脏代偿失调，应立即实施治疗。从 PPH 的诊断开始，一线措施应确保协调护理行动，包括血液衍生物的可用性、建立容量替代条件、氧疗、以及识别和及时治疗出血原因。个体化液体复苏应从温热晶体液开始，限制在 3.5L 以内。
