title: Usefulness of shock indicators for determining the need for blood transfusion after massive obstetric hemorrhage.
abstract: OBJECTIVE
  Massive obstetric hemorrhage (MOH) requires prompt transfusion of red blood cells and coagulation factors. Because MOH has a diverse pathogenesis, the shock index (SI) alone may be insufficient for determining blood transfusion. Here, we retrospectively analyzed patients with MOH to determine usefulness of the indicators of shock including the SI in evaluating the need for blood transfusion.
  
  
  METHODS
  We reviewed records of 80 emergency referral patients who had received blood transfusions at our department between 1 January 2009 and 31 July 2011. The shock indicators for blood transfusion are estimated blood loss, fibrinogen level, hemoglobin concentration, the Japan Society of Obstetrics and Gynecology disseminated intravascular coagulation (JSOG DIC) score and the SI. The strength of the correlation of each shock indicator with the transfusion volume was ranked using Spearman's rank correlation coefficient-ρ and multivariate analysis.
  
  
  RESULTS
  Although the SI showed significant positive correlation with blood transfusion volume for red blood cell concentrate (RCC) and fresh frozen plasma (FFP) in patients with dilutional coagulopathy, a stronger correlation was seen with the fibrinogen level and JSOG DIC score. In patients with consumptive coagulopathy, the strongest correlation was seen between RCC transfusion volume and fibrinogen level, and between FFP transfusion volume and JSOG DIC score followed by fibrinogen level. In multivariate analysis, only fibrinogen level was significantly associated with both RCC and FFP massive transfusion.
  
  
  CONCLUSIONS
  Because MOH has a diverse pathogenesis, various indicators should be evaluated. Among shock indicators, fibrinogen level was the best indicator of the need for blood transfusion following MOH.
authors.affiliation: Center for Maternal, Fetal and Neonatal Medicine, Saitama Medical Center, Saitama Medical University, Kawagoe, Japan.
authors.forename: Sumiko
authors.initials: S
authors.lastname: Era
authors.forename: Shigetaka
authors.initials: S
authors.lastname: Matsunaga
authors.forename: Hideyoshi
authors.initials: H
authors.lastname: Matsumura
authors.forename: Yoshihiko
authors.initials: Y
authors.lastname: Murayama
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Takai
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Seki
mesh_terms: D001803:Blood Transfusion; D005260:Female; D006801:Humans; D006473:Postpartum Hemorrhage / Q000628:therapy; D011247:Pregnancy; D012189:Retrospective Studies; D012720:Severity of Illness Index; D012771:Shock, Hemorrhagic / Q000175:diagnosis* / Q000209:etiology
keywords: blood transfusion; coagulation factor; fibrinogen; massive obstetric hemorrhage; shock index