休克指数预测阴道分娩产后出血的价值：一项多中心随机对照试验的二次分析。

Shock index as a predictor of postpartum haemorrhage after vaginal delivery: Secondary analysis of a multicentre randomised controlled trial.

机构信息

Université Paris Cité, Women's Health IHM, U1153, Centre of Research In Epidemiology and Statistics, Obstetrical, Perinatal and Paediatric Epidemiology EPOPé Research Team, INSERM, INRAE, Paris, France.

Department of Obstetrics and Gynaecology, Bordeaux University Hospital, Bordeaux, France.

出版信息

BJOG. 2024 Feb;131(3):343-352. doi: 10.1111/1471-0528.17634. Epub 2023 Aug 9.

DOI:10.1111/1471-0528.17634

PMID:37555480

Abstract

OBJECTIVE

To describe the shock index (SI) distribution during the first 2 hours after delivery and to evaluate its performance when measured 15 and 30 minutes after delivery for predicting postpartum haemorrhage (PPH) occurrence in the general population of parturients after vaginal delivery.

DESIGN

Secondary analysis of a multicentre randomised controlled trial testing prophylactic administration of tranexamic acid versus placebo in addition to prophylactic oxytocin to prevent PPH.

SETTING

15 French maternity units in 2015-2016.

SAMPLE

3891 women with a singleton live fetus ≥35 weeks, born vaginally.

METHODS

For each PPH-related predicted outcome, we calculated the area under the receiver operating characteristic curve (AUROC) values of the SI at 15 and 30 minutes after delivery and its predictive performance for SI cut-off values of 0.7, 0.9 and 1.1.

MAIN OUTCOME MEASURES

Quantitative blood loss ≥1000 ml (QBL ≥1000 ml) measured in a graduated collector bag and provider-assessed clinically significant PPH (cPPH).

RESULTS

Prevalence of QBL ≥1000 ml and cPPH was respectively 2.7% (104/3839) and 9.1% (354/3891). The distributions of the SI at 15 and 30 minutes after delivery were similar with a median value of 0.73 and 97th percentile of 1.11 for both. The AUROC values of the 15-minute SI for discriminating QBL ≥1000 ml and cPPH were respectively 0.66 (lower limit of the 95% confidence interval [LCI] 0.60) and 0.56 (LCI 0.52); and for the 30-minute SI 0.68 (LCI 0.61) and 0.49 (LCI 0.43).

CONCLUSIONS

The shock index at 15 and 30 minutes after delivery did not satisfactorily predict either QBL ≥1000 ml or clinical PPH.

摘要

目的

描述分娩后 2 小时内的休克指数（SI）分布，并评估其在分娩后 15 分钟和 30 分钟测量时预测产后出血（PPH）发生的性能，用于阴道分娩后产妇的一般人群。

设计

一项多中心随机对照试验的二次分析，该试验测试了预防性给予氨甲环酸与安慰剂联合预防性催产素预防 PPH 的效果。

设置

2015-2016 年的 15 个法国产科单位。

样本

3891 名具有单胎活胎≥35 周，阴道分娩的女性。

方法

对于每个与 PPH 相关的预测结果，我们计算了 15 分钟和 30 分钟时 SI 的受试者工作特征曲线（ROC）下面积（AUROC）值，以及 SI 截断值为 0.7、0.9 和 1.1 时的预测性能。

主要观察指标

在刻度收集袋中测量的定量失血≥1000ml（QBL≥1000ml）和提供者评估的临床显著 PPH（cPPH）。

结果

QBL≥1000ml 和 cPPH 的发生率分别为 2.7%（3839 例中的 104 例）和 9.1%（3891 例中的 354 例）。分娩后 15 分钟和 30 分钟时 SI 的分布相似，中位数分别为 0.73，第 97 百分位数分别为 1.11。15 分钟 SI 对 QBL≥1000ml 和 cPPH 的鉴别诊断 AUC 值分别为 0.66（95%置信区间下限[LCI]0.60）和 0.56（LCI 0.52）；30 分钟 SI 的 AUC 值分别为 0.68（LCI 0.61）和 0.49（LCI 0.43）。