Download PDF
Am J Perinatol 2019; 36(13): 1332-1336
DOI: 10.1055/s-0039-1688823
SMFM Fellowship Series Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Effect of Implementing Quantitative Blood Loss Assessment at the Time of Delivery

Elizabeth Coviello 
1   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, MedStar Washington Hospital Center, Washington, District of Columbia
2   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, MedStar Georgetown University Hospital, Washington, District of Columbia
,
Sara Iqbal
1   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, MedStar Washington Hospital Center, Washington, District of Columbia
,
Tetsuya Kawakita 
1   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, MedStar Washington Hospital Center, Washington, District of Columbia
2   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, MedStar Georgetown University Hospital, Washington, District of Columbia
,
Rebecca Chornock
3   Department of Obstetrics and Gynecology, MedStar Washington Hospital Center, Washington, District of Columbia
,
Megan Cheney
3   Department of Obstetrics and Gynecology, MedStar Washington Hospital Center, Washington, District of Columbia
,
Sameer Desale
4   Department of Biostatistics and Biomedical Informatics, MedStar Health Research Institute, Hyattsville, Maryland
,
Melissa Fries
1   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, MedStar Washington Hospital Center, Washington, District of Columbia
› Author Affiliations Funding This project was funded by the Department of Obstetrics and Gynecology at MedStar Washington Hospital Center.
Further Information

Publication History

13 November 2018

02 April 2019

Publication Date:
14 May 2019 (online)

    Permissions and Reprints

Abstract

Objective To evaluate the ability of estimated blood loss (EBL) and quantitative blood loss (qBL) to predict need for blood transfusion in women with postpartum hemorrhage (PPH).

Study Design This is a retrospective chart review that identified women with PPH (>1,000 mL for vaginal or cesarean delivery) between September 2014 and August 2015, reported by EBL (n = 92), and October 2015 and September 2016, reported by qBL (n = 374). The primary metric was the area under the receiver-operating characteristic curve for blood transfusion.

Results The rate of PPH by EBL and qBL was 2.8 and 10.8%, respectively (p < 0.01). The rate of transfusion for women meeting criteria for PPH by EBL and QBL were 2% (66/3,307) and 2.7% (93/3,453), respectively (p = 0.06). Postpartum transfusion was predicted by an EBL of 1,450 mL with AUC 0.826 and qBL 1,519 mL with AUC 0.764, for all modes of delivery. Postpartum vital signs and change in pre- and postdelivery hematocrit were poor predictors for transfusion.

Conclusion The rates of PPH increased with the implementation of qBL. Overall, qBL did not perform better than EBL in predicting the need for blood transfusion.

Keywords

postpartum hemorrhage - blood transfusion - quantitative blood loss - estimated blood loss

Note

This study was presented in poster format at the 38th Annual Pregnancy Meeting, Society for Maternal-Fetal Medicine, Dallas, TX, January 29–February 2, 2018.


 

  • References

  • 1 Main EK, Goffman D, Scavone BM. , et al; National Partnership for Maternal Safety; Council on Patient Safety in Women's Health Care. National Partnership for maternal safety: consensus bundle on obstetric hemorrhage. Obstet Gynecol 2015; 126 (01) 155-162
    CrossrefPubMedGoogle Scholar
  • 2 American College of Obstetricians and Gynecologists. Practice bulletin no. 183: postpartum hemorrhage. . Obstet Gynecol 2017; 130: e168
    CrossrefPubMedGoogle Scholar
  • 3 Creasy R. Maternal cardiovascular, respiratory and renal adaptation to pregnancy. In: Creasy and Resnik's Maternal-Fetal Medicine Principles and Practice, 7th ed. Philadelphia, PA: Elsevier; 2014: 93
    Google Scholar
  • 4 Al Kadri HM, Al Anazi BK, Tamim HM. Visual estimation versus gravimetric measurement of postpartum blood loss: a prospective cohort study. Arch Gynecol Obstet 2011; 283 (06) 1207-1213
    CrossrefPubMedGoogle Scholar
  • 5 Prasertcharoensuk W, Swadpanich U, Lumbiganon P. Accuracy of the blood loss estimation in the third stage of labor. Int J Gynaecol Obstet 2000; 71 (01) 69-70
    CrossrefPubMedGoogle Scholar
  • 6 Razvi K, Chua S, Arulkumaran S, Ratnam SS. A comparison between visual estimation and laboratory determination of blood loss during the third stage of labour. Aust N Z J Obstet Gynaecol 1996; 36 (02) 152-154
    CrossrefPubMedGoogle Scholar
  • 7 Newton M, Mosey LM, Egli GE, Gifford WB, Hull CT. Blood loss during and immediately after delivery. Obstet Gynecol 1961; 17: 9-18
    PubMedGoogle Scholar
  • 8 Duthie SJ, Ven D, Yung GL, Guang DZ, Chan SY, Ma HK. Discrepancy between laboratory determination and visual estimation of blood loss during normal delivery. Eur J Obstet Gynecol Reprod Biol 1991; 38 (02) 119-124
    CrossrefPubMedGoogle Scholar
  • 9 Brant HA. Precise estimation of postpartum haemorrhage: difficulties and importance. BMJ 1967; 1 (5537): 398-400
    CrossrefPubMedGoogle Scholar
  • 10 Larsson C, Saltvedt S, Wiklund I, Pahlen S, Andolf E. Estimation of blood loss after cesarean section and vaginal delivery has low validity with a tendency to exaggeration. Acta Obstet Gynecol Scand 2006; 85 (12) 1448-1452
    CrossrefPubMedGoogle Scholar
  • 11 Bingham D, Lyndon A, Lagrew D, Main EK. A state-wide obstetric hemorrhage quality improvement initiative. MCN Am J Matern Child Nurs 2011; 36 (05) 297-304
    CrossrefPubMedGoogle Scholar
  • 12 Main EK, Goffman D, Scavone BM. , et al. National Partnership for maternal safety: consensus bundle on obstetric hemorrhage. J Midwifery Womens Health 2015; 60 (04) 458-464
    CrossrefPubMedGoogle Scholar
  • 13 Atukunda EC, Mugyenyi GR, Obua C. , 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 (04) e0152408
    CrossrefPubMedGoogle Scholar
  • 14 Sheldon WR, Blum J, Vogel JP, Souza JP, Gülmezoglu AM, Winikoff B. ; WHO Multicountry Survey on Maternal and Newborn Health Research Network. Postpartum haemorrhage management, risks, and maternal outcomes: findings from the World Health Organization Multicountry Survey on Maternal and Newborn Health. BJOG 2014; 121 (Suppl. 01) 5-13
    CrossrefPubMedGoogle Scholar
  • 15 Lu MC, Fridman M, Korst LM. , et al. Variations in the incidence of postpartum hemorrhage across hospitals in California. Matern Child Health J 2005; 9 (03) 297-306
    CrossrefPubMedGoogle Scholar
  • 16 Doctorvaladan SV, Jelks AT, Hsieh EW, Thurer RL, Zakowski MI, Lagrew DC. Accuracy of blood loss measurement during cesarean delivery. AJP Rep 2017; 7 (02) e93-e100
    Article in Thieme ConnectPubMedGoogle Scholar
  • 17 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) 134-139
    Article in Thieme ConnectPubMedGoogle Scholar