Visual estimation of blood loss versus quantification of blood loss after vaginal birth using an innovative drape: a prospective study
DOI:
https://doi.org/10.18203/2320-1770.ijrcog20205780Keywords:
Blood collection drape, Calculated quantitative assessment of blood loss, Estimated blood loss, Innovative drape, Postpartum blood loss, Quantitative assessment of blood lossAbstract
Background: This study was done to compare the accuracy of visual estimation of blood loss (EBL) and quantitative assessment of blood loss (QBL, sum of volumetric and gravimetric assessment) against a reference standard i.e. calculated QBL (C-QBL) and also with each other after vaginal birth.
Methods: Prospective observational cohort study conducted at Pt. JNM medical College Raipur, Chhattisgarh, India and involved 101 low risk women after vaginal birth. Women were allocated alternately to EBL or QBL group (volumetric component of measured blood loss was done with an innovative low cost drape prepared with a plastic apron at the point of care. Gravimetric component was measured by weight difference of the mops and pads before and after use). C-QBL was calculated for each case with a standard formula. Main outcome measure was comparing the correlation coefficient of EBL and QBL each with C-QBL.
Results: The mean blood loss in 51 women of EBL group and 50 women of QBL group was 275.29 ml and 380 ml respectively. Pearson’s correlation coefficient (r) of EBL with C-QBL was 0.4984 (weak correlation) compared to that of QBL with C-QBL (r=0.9093, strong positive correlation). The error of underestimation by EBL compared to QBL was 28% (mean=104.71 ml p<0.0001). The relative risk (RR) of underestimating blood loss of >500 ml by EBL method was 5 (95% CI .605-41.3).
Conclusions: Visual EBL should be replaced with QBL for measurement of postpartum blood loss. Using innovative under-buttock low cost drape greatly helps in routine QBL.
References
Roth GA, Abate D, Abate KH, Abay SM, Abbafati C, Abbasi N, et al. Global, regional, and national age-sex-specific mortality for 282 causes of death in 195 countries and territories, 1980-2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet. 2018;392(10159):1736-88.
Nathan LM. An overview of obstetric hemorrhage. Semin Perinatol. 2019;43:2-4.
American College of Obstetricians and Gynecologists. Quantitative blood loss in obstetric hemorrhage. ACOG Committee Opinion No. 794. Obstet Gynecol. 2019;134:e150-6.
Seacrist MJ, VanOtterloo LR, Morton CH, Main EK. Quality improvement opportunities identified through case review of pregnancy-related deaths from obstetric hemorrhage. J Obstet Gynecol Neonat Nurs. 2019;48:288-99.
Saoud F, Stone A, Nutter A, Hankins GD, Saade GR, Saad AF. Validation of a new method to assess estimated blood loss in the obstetric population undergoing cesarean delivery. Am J Obstet Gynecol. 2019;221(3):267.e1-6.
Rubenstein A, Tully G, Thurer R. Accurate assessment of blood loss during cesarean delivery improves estimate of postoperative hemoglobin [17B]. Obstet Gynecol. 2018;131:23S-4S.
Lyndon A, McNulty J, Wal BV, Gabel K, Huwe V, Main E. Cumulative quantitative assessment of blood loss. California Maternal Quality Care Collaborative (CMQCC) obstetric hemorrhage toolkit Version 2.0.
Mahadalkar P, Podder L, Memchoubi JD, Pottal S, Devi S, Gadade M. Accuracy of visual estimation of blood loss by simulated learning package. Int J Nurs Res Pract. 2015;2(1):20-3.
Hancock A, Weeks AD, Lavender DT. Is accurate and reliable blood loss estimation the “crucial step” in early detection of postpartum haemorrhage: an integrative review of the literature. BMC Pregnanc Childbirth. 2015;15:230.
Andrikopoulou M, D’Alton ME. Postpartum hemorrhage: early identification challenges. Semin Perinatol. 2019;43:11-7.
Natrella M, Di Naro E, Loverro M, Benshalom-Tirosh N, Trojano G, Tirosh D, et al. The more you lose the more you miss: accuracy of postpartum blood loss visual estimation.A systematic review of the literature. J Matern Fetal Neonat Med. 2018;31:106-15.
Lilley G, Burkett-St-Laurent D, Precious E, Bruynseels D, Kaye A, Sanders J, et al. Measurement of blood loss during postpartum haemorrhage. Int J Obstet Anesth. 2015;24(1):8-14.
Lertbunnaphong T, Lapthanapat N, Leetheeragul J, Hakularb P, Ownon A. Postpartum blood loss: visual estimation versus objective quantification with a novel birthing drape. Singapore Med J. 2016;57(6):325-8.
Rubenstein AF, Zamudio S, Al-Khan A, Douglas C, Sledge S, Tully G, et al. Clinical experience with the implementation of accurate measurement of blood loss during caesarean delivery: influences on hemorrhage recognition and allogeneic transfusion. Am J Perinatol. 2018;35:655-9.
Powell E, James D, Collis R, Collins PW, Pallmann P, Bell S. Introduction of standardized, cumulative quantitative measurement of blood loss into routine maternity care. J Matern Fet Neonat Med. 2020:1-7.
Katz D, Wang R, O’Neil L, Gerber C, Lankford A, Rogers T, et al. The association between the introduction of quantitative assessment of postpartum blood loss and institutional changes in clinical practice: an observational study. Int J Obstet Anesth. 2020;42:4-10.
Goffman D, Ananth CV, Fleischer A, D’Alton M, Lavery JA, Smiley R, et al. The New York State Safe Motherhood Initiative: early impact of obstetric hemorrhage bundle implementation. Safe Motherhood Initiative Obstetric Hemorrhage Work Group. Am J Perinatol. 2019;36(13):1344-50.
Main EK, Cape V, Abreo A, Vasher J, Woods A, Carpenter A, et al. Reduction of severe maternal morbidity from hemorrhage using a state perinatal quality collaborative. Am J Obstet Gynecol. 2017;216:298.e1-11.
Main EK, Goffman D, Scavone BM, Low LK, Bingham D, Fontaine PL, et al. National partnership for maternal safety consensus bundle on obstetric hemorrhage. J Midwife Women Health. 2015;60(4):458-64.
Goffman D, Moroz L. Introduction. Semin Perinatol 2019; 43(1):1.
Bingham D, Scheich B, Bateman BT. Structure, process, and outcome data of AWHONN’s postpartum hemorrhage quality improvement project. J Obstet Gynecol Neonatal Nurs. 2018;47:707-18.
Shields LE, Wiesner S, Fulton J, Pelletreau B. Comprehensive maternal hemorrhage protocols reduce the use of blood products and improve patient safety. Am J Obstet Gynecol. 2015;212:272-80.
Patel A, Goudar SS, Geller SE, Kodkany BS, Edlavitch SA, Wagh K, et al. Drape estimation vs. visual assessment for estimating postpartum hemorrhage. Int J Gynecol Obstet. 2006;93(3):220-4.
Atukunda EC, Mugyenyi GR, Obua C, Atuhumuza EB, Musinguzi N, Tornes YF, et al. Measuring post-partum haemorrhage in low-resource settings: the diagnostic validity of weighed blood loss versus quantitative changes in hemoglobin. PLoS One. 2016;11(4).
Diaz V, Abalos E, Carroli G. Methods for blood loss estimation after vaginal birth. Cochrane Database Systemat Rev. 2018;9:CD010980.
Mishra N, Baghel M, Gupta A, Shrivastava S, Chandrawanshi H. Use of Innovative low cost drape for assessment of blood loss during delivery: a report. J South Asian Federation Obstet Gynaecol. 2019;11(1):30-4.
Wasley SR, Holmes HJ, Kauffman RP, Gouldy D. Estimating blood loss: which is superior. Am J Obstet Gynaecol. 2020;222(1):S345-6.
Kahr MK, Brun R, Zimmermann R, Franke D, Haslinger C. Validation of a quantitative system for real-time measurement of postpartum blood loss. Arch Gynecol Obstet. 2018;298(6):1071-7.
Hire MG, Lange EM, Vaidyanathan M, Armour KL, Toledo P. Effect of quantification of blood loss on activation of a postpartum hemorrhage protocol and use of resources. J Obstet Gynecol Neonat Nurs. 2020;49(2):137-43.
Einerson BD, Miller ES, Grobman WA. Does a postpartum hemorrhage patient safety program result in sustained changes in management and outcomes? Am J Obstet Gynecol. 2015;212:140-4.
Doctorvaladan SV, Jelks A, Hsieh E. Accuracy of blood loss measurement during cesarean delivery. AJP Rep. 2017;07(02):e93-100.
Coviello E, Iqbal S, Kawakita T, Chornock R, Cheney M, Desale S, et al. Effect of implementing quantitative blood loss assessment at the time of delivery. Am J Perinatol. 2019;36(13):1332-6.
Hamm RF, Wang E, Romanos A, O'Rourke K, Srinivas SK. Implementation of quantification of blood loss does not improve prediction of hemoglobin drop in deliveries with average blood loss. Am J Perinatol. 2018;35(02):134-9.
Mavrides E, Allard S, Chandraharan E, Collins P, Green L, Hunt BJ, et al. Prevention and management of postpartum haemorrhage. BJOG. 2016;124:e106-49.
Fedoruk K. Seligman KM, Carvalho B, Butwick AJ. Assessing the association between blood loss and postoperative hemoglobin after cesarean delivery: a prospective study of 4 blood loss measurement modalities. Anesth Analg. 2019;128:926-32.
