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Visual estimation versus gravimetric measurement of postpartum blood loss: a prospective cohort study

  • Materno-fetal Medicine
  • Published:
Archives of Gynecology and Obstetrics Aims and scope Submit manuscript

Abstract

Purpose

One of the major problems in international literature is how to measure postpartum blood loss with accuracy. We aimed in this research to assess the accuracy of visual estimation of postpartum blood loss (by each of two main health-care providers) compared with the gravimetric calculation method.

Methods

We carried out a prospective cohort study at King Abdulaziz Medical City, Riyadh, Saudi Arabia between 1 November 2009 and 31 December 2009. All women who were admitted to labor and delivery suite and delivered vaginally were included in the study. Postpartum blood loss was visually estimated by the attending physician and obstetrics nurse and then objectively calculated by a gravimetric machine. Comparison between the three methods of blood loss calculation was carried out.

Results

A total of 150 patients were included in this study. There was a significant difference between the gravimetric calculated blood loss and both health-care providers’ estimation with a tendency to underestimate the loss by about 30%. The background and seniority of the assessing health-care provider did not affect the accuracy of the estimation. The corrected incidence of postpartum hemorrhage in Saudi Arabia was found to be 1.47%.

Conclusion

Health-care providers tend to underestimate the volume of postpartum blood loss by about 30%. Training and continuous auditing of the diagnosis of postpartum hemorrhage is needed to avoid missing cases and thus preventing associated morbidity and mortality.

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References

  1. World Health Organization: The World Report 2005. Attending to 136 million births, every year 2005. Make every mother and child count (2005) In: Geneva: the World Health Organization, pp 62–63

  2. Tourne G, Collet F, Lasnier P, Seffert P (2004) Usefulness of a collecting bag for the diagnosis of post-partum hemorrhage. J Gynecol Obstet Biol Reprod (Paris) 33(3):229–234

    CAS  Google Scholar 

  3. Chua S, Ho LM, Vanaja K, Nordstrom L, Roy AC, Arulkumaran S (1998) Validation of a laboratory method of measuring postpartum blood loss. Gynecol Obstet Invest 46:31–33

    Article  PubMed  CAS  Google Scholar 

  4. Patel A, Goudar SS, Geller SE, Kodakany BS, Edlavitch SA, Wagh K, Patted SS, Naik VA, Moss N, Derman RJ (2006) Drape estimation vs. visual assessment for estimating postpartum hemorrhage. Int J Gynaecol Obstet 93(3):220–224

    Article  PubMed  CAS  Google Scholar 

  5. Bose P, Regan F, Paterson-Brown S (2006) Improving the accuracy of estimated blood loss at obstetric haemorrhage using clinical reconstructions. BJOG 113(8):919–924

    Article  PubMed  CAS  Google Scholar 

  6. Razvi K, Chua S, Arulkumaran S, Ratnam SS (1996) A comparison between visual estimation and laboratory determination of blood loss during the 3rd stage of labour. Aust NZ J Obstet Gynaecol 36(2):152–154

    Article  CAS  Google Scholar 

  7. Meiser A, Casagranda O, Skipka G, Laubenthal H (2001) Quantification of blood loss. How precise is visual estimation and what does its accuracy depend on? Anaesthesist 50(1):13–20

    Article  PubMed  CAS  Google Scholar 

  8. Newton M, Mosey LM, Egli GE, Gifford WB, Hull CT (1961) Blood loss during and immediately after delivery. Obstet Gynecol 17:9–18

    PubMed  CAS  Google Scholar 

  9. Dildy GA, Paine AR, George NC, Velasco C (2004) Estimating blood loss: can teaching significantly improve visual estimation? Obstet Gynecol 104(3):601–606

    Article  PubMed  Google Scholar 

  10. Patton K, Funk DL, McErlean M, Bartfield JM (2001) Accuracy of estimation of external blood loss by EMS personnel. J Trauma 50(5):914–916

    Article  PubMed  CAS  Google Scholar 

  11. Lee MH, Ingvertsen BT, Kirpensteijn J, Jensen AL, Kristensen AT (2006) Quantification of surgical blood loss. Vet Surg 35(4):388–393

    Article  PubMed  Google Scholar 

  12. Lain SJ, Roberts CL, Hadfield RM, Bell JC, Morris JM (2008) How accurate is the reporting of obstetric haemorrhage in hospital discharge data? A validation study. Aust N Z J Obstet Gynaecol 48(5):481–484

    Article  PubMed  Google Scholar 

  13. Al-Kadri HM, Tariq S, Tamim HM (2009) Risk factors for postpartum hemorrhage among Saudi women. Saudi Med J 30(10):1305–1310

    PubMed  Google Scholar 

  14. Larsson C, Saltvedt S, Wiklund I, Pahlen S, Andolf E (2006) Estimation of blood loss after cesarean section and vaginal delivery has low validity with a tendency to exaggeration. Acta Obstet Gynecol Scand 85(12):1448–1452

    Article  PubMed  Google Scholar 

  15. Yoong W, Karavolos S, Damodaram M, Madgwick K, Milestone N, Al-Habib A, Fakokunde A, Okolo S (2009) Observer accuracy and reproducibility of visual estimation of blood loss in obstetrics: how accurate and consistent are health-care professionals? Arch Gynecol Obstet 281(2):207–213

    Article  PubMed  Google Scholar 

  16. Tebruegge M, Misra I, Pantazidou A, Padhye A, Maity S, Dwarakanathan B, Donath S, Curtis N, Nerminathan V (2009) Estimating blood loss: comparative study of the accuracy of parents and health care professionals. Pediatrics 124(4):e729–e736

    Article  PubMed  Google Scholar 

  17. Wandabwa J, Doyle P, Todd J, Ononge S, Kiondo P (2008) Risk factors for severe postpartum haemorrhage in Mulago Hospital, Kampala, Uganda. East Afr Med J 85(2):64–71

    PubMed  CAS  Google Scholar 

  18. Cameron CA, Roberts CL, Bell J, Fischer W (2007) Getting an evidence-based post-partum haemorrhage policy into practice. Aust N Z J Obstet Gynaecol 47(3):169–175

    Article  PubMed  Google Scholar 

  19. Gulmezoglu AM (2004) Postpartum haemorrhage (1997–2002). Monitoring and evaluation department of reproductive health and research. In: WHO, Geneva, 25–26 May 2004

  20. Benedetti T (2002) Obstetric haemorrhage. In: Gabbe SG, Niebyl JR, Simpson JL (eds) A pocket companion to obstetrics, 4th edn. Churchill Livingstone, New York

    Google Scholar 

  21. Maslovitz S, Barkai G, Lessing JB, Ziv A, Many A (2008) Improved accuracy of postpartum blood loss estimation as assessed by simulation. Acta Obstet Gynecol Scand 87(9):929–934

    Article  PubMed  Google Scholar 

  22. Glover P (2003) Blood loss at delivery: how accurate is your estimation? Aust J Midwifery 16(2):21–24

    Article  PubMed  Google Scholar 

  23. Buckland SS, Homer CS (2007) Estimating blood loss after birth: using simulated clinical examples. Women Birth 20(2):85–88

    Article  PubMed  Google Scholar 

  24. Sukprasert M, Choktanasiri W, Ayudhya NI, Promsonthi P, O-Prasertsawat P (2006) Increase accuracy of visual estimation of blood loss from education programme. J Med Assoc Thail 89(Suppl 4):S54–S59

    Google Scholar 

  25. Pavelka R, Linkesch W, Kofler E (1981) Hematologic parameters and iron state in the perinatal period. Arch Gynecol 230(4):275–281

    Article  PubMed  CAS  Google Scholar 

  26. Grathwohl KW, Bruns BJ, LeBrun CJ, Ohno AK, Dillard TA, Cushner HM (1996) Does hemodilution exist? Effects of saline infusion on hematologic parameters in euvolemic subjects. South Med J 89(1):51–55

    Article  PubMed  CAS  Google Scholar 

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The authors declare no conflict of interest.

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Correspondence to Hanan M. F. Al Kadri.

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Al Kadri, H.M.F., Al Anazi, B.K. & Tamim, H.M. Visual estimation versus gravimetric measurement of postpartum blood loss: a prospective cohort study. Arch Gynecol Obstet 283, 1207–1213 (2011). https://doi.org/10.1007/s00404-010-1522-1

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  • DOI: https://doi.org/10.1007/s00404-010-1522-1

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