Implementation of Quantification of Blood Loss Does Not Improve Prediction of Hemoglobin Drop in Deliveries with Average Blood Loss

Rebecca F. Hamm; Eileen Wang; April Romanos; Kathleen O'Rourke; Sindhu K. Srinivas

doi:10.1055/s-0037-1606275

American Journal of Perinatology, Table of Contents

Am J Perinatol 2018; 35(02): 134-139
DOI: 10.1055/s-0037-1606275

Original Article

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

Implementation of Quantification of Blood Loss Does Not Improve Prediction of Hemoglobin Drop in Deliveries with Average Blood Loss

Rebecca F. Hamm

¹Department of Obstetrics and Gynecology, Maternal and Child Health Research Program, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania

,

Eileen Wang

¹Department of Obstetrics and Gynecology, Maternal and Child Health Research Program, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania

,

April Romanos

¹Department of Obstetrics and Gynecology, Maternal and Child Health Research Program, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania

,

Kathleen O'Rourke

¹Department of Obstetrics and Gynecology, Maternal and Child Health Research Program, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania

,

Sindhu K. Srinivas

¹Department of Obstetrics and Gynecology, Maternal and Child Health Research Program, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania

› Author Affiliations

Abstract

Objective The National Partnership for Maternal Safety released a postpartum hemorrhage bundle in 2015 recommending quantification of blood loss (QBL) for all deliveries. We sought to determine whether QBL more accurately predicts hemoglobin (Hb) drop than visually estimated blood loss (EBL).

Study Design This is a prospective observational study. Preintervention data (PRE) were collected on all deliveries between October 15, 2013 and December 15, 2013. Deliveries were included if EBL, admission Hb, and 12-hour postpartum Hb (12hrCBC) were available. QBL was implemented in July 2015. Postintervention data (POST) were collected between October 20, 2015 and December 20, 2015. A total of 500 mL EBL was predicted to result in 1 g/dL Hb drop at 12hrCBC. Student's t-test was used to compare the means.

Results A total of 592 of 626 (95%) PRE and 583 of 613 (95%) POST deliveries were included. Overall, 278 (48%) POST deliveries had QBL recorded. In both PRE and POST, actual Hb drop differed from predicted by 0.6 g/dL in both groups of deliveries. When evaluating deliveries with EBL > 1,000 mL, QBL in POST was slightly better at predicting Hb drop versus EBL in PRE, although not statistically significant (0.2 vs. 0.5 g/dL, p = 0.17).

Conclusion In all deliveries, QBL does not predict Hb drop more accurately than EBL. The decision to perform QBL needs to balance accuracy with a resource intense measurement process.

Keywords

postpartum hemorrhage - quantitative blood loss - estimated blood loss - bundle - quantification of blood loss

Full Text

References

References
1 World Health Organization. Maternal Mortality in 2000: Estimates Developed by WHO, UNICEF, and UNFPA. Geneva, Switzerland: World Health Organization; 2004
2 AbouZahr C. Global burden of maternal death and disability. Br Med Bull 2003; 67: 1-11
3 DʼAlton ME, Main EK, Menard MK, Levy BS. The National Partnership for Maternal Safety. Obstet Gynecol 2014; 123 (05) 973-977
4 Kacmar RM, Mhyre JM, Scavone BM, Fuller AJ, Toledo P. The use of postpartum hemorrhage protocols in United States academic obstetric anesthesia units. Anesth Analg 2014; 119 (04) 906-910
5 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
6 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
7 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
8 Yoong W, Karavolos S, Damodaram M. , et al. Observer accuracy and reproducibility of visual estimation of blood loss in obstetrics: how accurate and consistent are health-care professionals?. Arch Gynecol Obstet 2010; 281 (02) 207-213
9 Hamm RF, Wang EY, Bastek JA, Srinivas SK. Assessing reVITALize: Should the definition of postpartum hemorrhage differ by mode of delivery?. Am J Perinatol 2017; 34 (05) 503-507
10 Tourné G, Collet F, Lasnier P, Seffert P. Usefulness of a collecting bag for the diagnosis of post-partum hemorrhage [in French]. J Gynecol Obstet Biol Reprod (Paris) 2004; 33 (03) 229-234
11 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
12 Hambly PR, Sainsbury MC. Perioperative Management for House Surgeons. Oxford, United Kingdom: Bios Scientific; 1996