Assessing and managing hypovolemic shock in puerperal women

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.