Accurate Assessment of Blood Loss during Cesarean Delivery Improves Estimation of Postoperative Hemoglobin

Andrew F. Rubenstein; Michael Block; Stacy Zamudio; Claudia Douglas; Sharon Sledge; Griffeth Tully; Robert L. Thurer

doi:10.1055/s-0038-1669397

American Journal of Perinatology, Inhaltsverzeichnis

Am J Perinatol 2019; 36(04): 434-439
DOI: 10.1055/s-0038-1669397

Original Article

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

Accurate Assessment of Blood Loss during Cesarean Delivery Improves Estimation of Postoperative Hemoglobin

Andrew F. Rubenstein

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

,

Michael Block

²Department of Anesthesia, Hackensack Meridian Health, Hackensack, New Jersey

,

Stacy Zamudio

³Division of Maternal-Fetal Medicine and Surgery, Department of Obstetrics and Gynecology, Hackensack Meridian Health, Hackensack, New Jersey

,

Claudia Douglas

⁴Department of Nursing, Institute for Evidence-Based Practice and Nursing Research, Hackensack University Medical Center, Hackensack Meridian Health, Hackensack, New Jersey

,

Sharon Sledge

⁵Department of Patient Safety and Quality, Center for Bloodless Medicine and Surgery, Hackensack Meridian Health, Hackensack, New Jersey

,

Griffeth Tully

⁶Medical Department, Gauss Surgical, Inc., Los Altos, California

,

Robert L. Thurer

⁶Medical Department, Gauss Surgical, Inc., Los Altos, California

› Institutsangaben

Abstract

Objective To determine if accurate blood loss determination during cesarean delivery can improve the prediction of postoperative hemoglobin levels.

Study Design This is 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 The correlation between the actual and predicted postoperative day 1 hemoglobin value (PPO1 Hgb) was better in the device group (R ² = 0.519, correlation = 0.720) than in the traditional group (R ² = 0.429, correlation = 0.655) (p = 0.005). For patients in the device group where the estimated blood loss was >1,000 mL (n = 53), the PPO1 Hgb was also better correlated with the actual value (R ² = 0.319, correlation = 0.565) than the predictions using visually estimated blood loss for those patients in the device group whose visual estimation was >1,000 mL (n = 32) (R ² = 0.035, correlation = 0.187) (p = 0.027).

Conclusion Implementation of a device that accurately measures blood loss allows for a better prediction of postoperative day 1 hemoglobin concentration than is possible using visual blood loss estimation. This improvement was seen in the entire patient group and was particularly prominent in patients with blood losses of > 1,000 mL.

Keywords

cesarean delivery - blood loss - transfusion - postpartum hemorrhage - quality - improvement

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