Practical Use of Shock Index in Caesarean Section Surgery

Initial Risk Stratification and Intervention

The American College of Surgeons recommends using a Shock Index (SI) >1 to categorize patients as "unstable" requiring immediate intervention 1
This approach aligns with trauma guidelines, where SI is useful for drawing attention to abnormal values, though it remains too insensitive to rule out major bleeding 2, 3

The American College of Obstetricians and Gynecologists recommends employing volumetric and gravimetric techniques rather than visual estimation to measure blood loss, as it is frequently underestimated 4
Recognize abnormal bleeding threshold: >1000 mL after cesarean delivery 4
Lactate >2 mmol/L is a more reliable indicator of shock than SI alone, according to the Society of Critical Care Medicine 5
Obtain rapid venous blood gas for hemoglobin and lactate measurement, and monitor base deficit as an alternative if lactate is unavailable 4, 5

If SI >1 on presentation, categorize as unstable and prepare for immediate bleeding control, as recommended by the European Society of Anesthesiology 1
Assemble a multidisciplinary team immediately when abnormal bleeding is recognized, according to the American College of Obstetricians and Gynecologists 4
Administer tranexamic acid 1g IV within 3 hours of bleeding onset, as recommended by the World Health Organization 4