A Prospective Study of Correlation Between Shock Index and Adverse Maternal Outcomes in Post Partum Hemorrhage in Department of Obstetrics and Gynaecology, SMS Medical College, Jaipur

Abstract Background: Postpartum hemorrhage (PPH) is one of the leading causes of maternal morbidity and mortality worldwide, particularly in low- and middle-income countries. Conventional hemodynamic parameters such as heart rate (HR) and systolic blood pressure (SBP) often fail to detect early hemodynamic compromise due to physiological adaptations in pregnancy. The shock index (SI), defined as HR/SBP, has emerged as a potential early predictor of adverse outcomes, but its utility in PPH remains underexplored. Objectives: To evaluate the correlation between SI and maternal outcomes in PPH and compare its predictive value with conventional parameters (HR and SBP). Methods: A prospective observational study was conducted in the Department of Obstetrics and Gynaecology, SMS Medical College, Jaipur, from April 2023 to March 2024. Forty women with PPH (≥500 mL blood loss after vaginal delivery or ≥1000 mL after cesarean) were enrolled after ethical clearance and informed consent. Demographic, clinical, and hemodynamic parameters (HR, SBP, mean arterial pressure [MAP], and SI) were recorded at 15-minute intervals during the first postpartum hour. Maternal outcomes assessed included transfusion requirements (>4 units), surgical interventions, intensive care unit (ICU) admission, vasopressor or ventilatory support, disseminated intravascular coagulation (DIC), multi-organ dysfunction syndrome (MODS), and maternal mortality. Data were analyzed using SPSS v29.0. Receiver operating characteristic (ROC) curves and area under the curve (AUROC) were used to evaluate diagnostic accuracy. Results: The mean age of participants was 27.2 ± 3.8 years, with most women residing in rural areas (92.5%) and 60% being unbooked. Trauma was the most common cause of PPH (65%), followed by uterine atony (27.5%) and retained placenta (7.5%). Hemodynamic assessment showed that SI was elevated at 15 minutes (1.06 ± 0.27) and declined to 0.70 ± 0.18 at 60 minutes, while SBP increased and HR decreased over time. An SI >1.08 predicted transfusion of ≥4 units with high accuracy (AUROC 0.89, sensitivity 84.2%, specificity 90.1%). An SI >1.5 predicted massive transfusion (>10 units) with AUROC 0.90 and NPV 98.8%. SI values >1.6–1.7 were strongly associated with ventilator support (AUROC 0.98), vasopressor use (AUROC 0.93), MODS (AUROC 0.91), and DIC, all with excellent sensitivity and negative predictive value. An SI >1.72 predicted maternal mortality with an AUROC of 0.98, 100% sensitivity, and 97.9% specificity. Conclusion: Shock index is a simple, rapid, and reliable bedside tool that outperforms conventional parameters in predicting adverse maternal outcomes in PPH. Its incorporation into routine obstetric practice and early warning systems can enhance timely recognition, facilitate appropriate interventions, and reduce preventable maternal morbidity and mortality.