Determining the Normal Values of Shock Index, Pulse Pressure, and ROPE in the Immediate Postpartum Period [15D]

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Shock index (SI), rate over pressure evaluation (ROPE) and the pulse pressure (PP) have been validated as indicators of hypovolemia. The objective of this study is to determine normal ranges for SI, PP and ROPE for postpartum women.


A chart review was performed from July 2012 to January 2015 at NSLIJ on postpartum women up to 24 hours postpartum who were not given anti-hypertensives, blood products or uterotonics. Logistic regression assessed associations between variables and time after delivery.


8,874 patient charts were analyzed. Patients who had C-sections, have an increase in SI up to 24 hours postpartum with 95% Prediction Interval of up to 1.1, while those who had a vaginal delivery, SI remained stable with 95% Prediction Interval of up to 1.03. For patients who had c sections, a decrease in PP was observed during the first 24 hours post-partum with 95% Prediction Intervals as low as 21.09. For patients who had vaginal deliveries or c sections, there is an increase in ROPE during the first 24 hours post-partum with 95% Prediction Interval (anti-logged) as high as 3.22. There were no clinically significant differences in these outcomes amongst different age groups or BMI categories.


Shock index greater than 1.1 is abnormal. Normal ranges for pulse pressure and anti log ROPE is 21.09 to 69.32 and 1.01 to 3.22, respectively. These outcomes are not affected by age or BMI. Further studies are needed to assess the utility of these values in improving outcomes during postpartum hemorrhage.

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