The Ability of Shock Index to Predict Refractory Postpartum Hemorrhage: A Secondary Analysis of the Prospective and Multicenter HELP MOM Study

Eur J Anaesthesiol . 2025 Jun 1;42(6):500–507. doi: 10.1097/EJA.0000000000002142. Postpartum hemorrhage (PPH), defined as blood loss >1000 mL, regardless of delivery modality, is a leading cause of morbidity and mortality among mothers (estimated at 8% to 20% of all maternal deaths). When coupled with modern treatments, early diagnosis of PPH leads to the best outcomes. Unfortunately, blood loss measurements are imprecise and often inaccurate, which may lead to delayed diagnosis and treatment. Shock index (SI), defined as systolic blood pressure (SBP) divided by heart rate (HR), identifies hemorrhage earlier than vital signs alone in patients with traumatic injury and is a potentially promising marker in identifying early PPH. This study was designed to assess the ability of the shock index to predict the progression from severe PPH to refractory PPH.