Clinical Experience with the Implementation of Accurate Measurement of Blood Loss during Cesarean Delivery: Influences on Hemorrhage Recognition and Allogeneic Transfusion

Andrew F. Rubenstein; Stacy Zamudio; Abdulla Al-Khan; Claudia Douglas; Sharon Sledge; Griffeth Tully; Robert L. Thurer

doi:10.1055/s-0037-1613675

American Journal of Perinatology, Inhaltsverzeichnis

Am J Perinatol 2018; 35(07): 655-659
DOI: 10.1055/s-0037-1613675

Original Article

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Clinical Experience with the Implementation of Accurate Measurement of Blood Loss during Cesarean Delivery: Influences on Hemorrhage Recognition and Allogeneic Transfusion

Andrew F. Rubenstein

¹Department of Obstetrics and Gynecology, Hackensack Meridian Health, Hackensack, New Jersey

,

Stacy Zamudio

²Division of Maternal-Fetal Medicine and Surgery, Department of Obstetrics and Gynecology, Hackensack Meridian Health, Hackensack, New Jersey

,

Abdulla Al-Khan

²Division of Maternal-Fetal Medicine and Surgery, Department of Obstetrics and Gynecology, Hackensack Meridian Health, Hackensack, New Jersey

,

Claudia Douglas

³Institute for Evidence Based Practice and Nursing Research, Hackensack University Medical Center, Hackensack Meridian Health, Hackensack, New Jersey

,

Sharon Sledge

⁴Department of Patient Safety and Quality, Center for Bloodless Medicine and Surgery, Hackensack Meridian Health, Hackensack, New Jersey

,

Griffeth Tully

⁵Gauss Surgical, Inc., Los Altos, California

,

Robert L. Thurer

⁵Gauss Surgical, Inc., Los Altos, California

› Institutsangaben

Abstract

Objective This article compares hemorrhage recognition and transfusion using accurate, contemporaneous blood loss measurement versus visual estimation during cesarean deliveries.

Study Design A retrospective cohort study using visually estimated blood loss (traditional, n = 2,025) versus estimates using a mobile application that photographs sponges and canisters and calculates their hemoglobin content (device, n = 756).

Results Blood loss > 1,000 mL was recognized in 1.9% of traditional visual estimation patients, while measured blood loss of > 1,000 mL occurred in 8.2% of device patients (p < 0.0001). In both groups, this was accompanied by a greater decrease in transfusion-adjusted hemoglobin levels than occurred in patients without hemorrhage (p < 0.0001). Despite similar transfusion rates (1.6% in both groups), fewer red cell units were given to transfused patients in the device group (1.83 ± 0.58 versus 2.56 ± 1.68 units; p = 0.038). None of the patients in the device group received plasma or cryoprecipitate. Seven patients in the traditional group received these products (p = 0.088). Device use was associated with shorter hospital stays (4.0 ± 2.3 versus 4.4 ± 2.9 days; p = 0.0006).

Conclusion The device identified hemorrhages more frequently than visual estimation. Device-detected hemorrhages appeared clinically relevant. Blood product transfusion was reduced possibly due to earlier recognition and treatment, although further studies are needed to verify the conclusion.

Keywords

cesarean delivery - blood loss - postpartum hemorrhage - quality improvement

Volltext

Referenzen

References
1 Berg CJ, Harper MA, Atkinson SM. , et al. Preventability of pregnancy-related deaths: results of a state-wide review. Obstet Gynecol 2005; 106 (06) 1228-1234
2 Lyndon A, Lagrew D, Shields L, Main E, Cape V. Improving Health Care Response to Obstetric Hemorrhage. (California Maternal Quality Care Collaborative Toolkit to Transform Maternity Care) Developed under contract #11–10006 with the California Department of Public Health; Maternal, Child and Adolescent Health Division. Stanford, CA: Published by the California Maternal Quality Care Collaborative, 3/17/15
3 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 (03) 272-280
4 Main EK, Goffman D, Scavone BM. , et al; National Parternship for Maternal Safety; Council for Patient Safety in Women's Health Care. National Partnership for Maternal Safety: consensus bundle on obstetric hemorrhage. Anesth Analg 2015; 121 (01) 142-148
5 Main EK, Cape V, Abreo A. , et al. Reduction of severe maternal morbidity from hemorrhage using a state perinatal quality collaborative. Am J Obstet Gynecol 2017; 216 (03) 298.e1-298.e11
6 Brasel KJ, Guse C, Gentilello LM, Nirula R. Heart rate: is it truly a vital sign?. J Trauma 2007; 62 (04) 812-817
7 Convertino VA, Moulton SL, Grudic GZ. , et al. Use of advanced machine-learning techniques for noninvasive monitoring of hemorrhage. J Trauma 2011; 71 (1, Suppl): S25-S32
8 Orlinsky M, Shoemaker W, Reis ED, Kerstein MD. Current controversies in shock and resuscitation. Surg Clin North Am 2001; 81 (06) 1217-1262
9 Bose P, Regan F, Paterson-Brown S. Improving the accuracy of estimated blood loss at obstetric haemorrhage using clinical reconstructions. BJOG 2006; 113 (08) 919-924
10 Schorn MN. Measurement of blood loss: review of the literature. J Midwifery Womens Health 2010; 55 (01) 20-27
11 Toledo P, Eosakul ST, Goetz K, Wong CA, Grobman WA. Decay in blood loss estimation skills after web-based didactic training. Simul Healthc 2012; 7 (01) 18-21
12 Association of Women's Health, Obstetric and Neonatal Nurses. Quantification of blood loss: AWHONN practice brief number 1. J Obstet Gynecol Neonatal Nurs 2015; 44 (01) 158-160
13 Johar RS, Smith RP. Assessing gravimetric estimation of intraoperative blood loss. J Gynecol Surg 1993; 9 (03) 151-154
14 Lilley G, Burkett-St-Laurent D, Precious E. , et al. Measurement of blood loss during postpartum haemorrhage. Int J Obstet Anesth 2015; 24 (01) 8-14
15 Holmes AA, Konig G, Ting V. , et al. Clinical evaluation of a novel system for monitoring surgical hemoglobin loss. Anesth Analg 2014; 119 (03) 588-594
16 Konig G, Holmes AA, Garcia R. , et al. In vitro evaluation of a novel system for monitoring surgical hemoglobin loss. Anesth Analg 2014; 119 (03) 595-600
17 Sharareh B, Woolwine S, Satish S, Abraham P, Schwarzkopf R. Real time intraoperative monitoring of blood loss with a novel tablet application. Open Orthop J 2015; 9: 422-426
18 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
19 Dilla AJ, Waters JH, Yazer MH. Clinical validation of risk stratification criteria for peripartum hemorrhage. Obstet Gynecol 2013; 122 (01) 120-126
20 Thurer RL, Katz RS, Parce P. , et al. By how much does a single unit transfusion increase the recipient's hemoglobin?. Transfusion 2010; 50 (suppl A): 135A
21 Shields LE, Smalarz K, Reffigee L, Mugg S, Burdumy TJ, Propst M. Comprehensive maternal hemorrhage protocols improve patient safety and reduce utilization of blood products. Am J Obstet Gynecol 2011; 205 (04) 368.e1-368.e8
22 Bingham D, Scheich B, Byfield R, Wilson B, Bateman BT. Postpartum hemorrhage preparedness elements vary among hospitals in New Jersey and Georgia. J Obstet Gynecol Neonatal Nurs 2016; 45 (02) 227-238