Evaluation of measured postpartum blood loss after vaginal delivery using a collector bag in relation to postpartum hemorrhage management strategies: a prospective observational study

Bamberg, Christian; Dollen, Katja Niepraschk-von; Mickley, Laura; Henkelmann, Anne; Hinkson, Larry; Kaufner, Lutz; Heymann, Christian von; Henrich, Wolfgang; Pauly, Franziska

doi:10.1515/jpm-2015-0200

Cited by 16 publications

(15 citation statements)

References 21 publications

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“…Similarly, Original Article SMJ many settings used collector bags as an effective tool for measuring postpartum blood loss after vaginal delivery in the third stage of labor. [3][4][5][6] However, the risk of PPH could be assessed in the antepartum or the first stage of labor as indicated in the study of Sittiparn and Siwadune that identified the risk factors associated with PPH and incorporated those risk factors into a risk score to predict PPH in normal labor. It could predict PPH in normal labor with sensitivity of 81.30% and specificity of 50.80% at the optimal cut-off score of four points or above.…”

Section: Introductionmentioning

confidence: 99%

Risk Scoring System for the Prediction of Postpartum Blood Loss over 300 mL at Chiang Rai Regional Hospital

I-Tuporn¹,

Ratanasiri

Nutravong

et al. 2019

Smj

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Objective: To develop an assessment tool for the prediction of postpartum blood loss over 300 mL and 500 mL after vaginal delivery. Methods: A retrospective case-control study of 504 (72 cases: 432 controls) pregnant women with gestational age of 28 weeks or above who underwent vaginal delivery at Chiang Rai Regional Hospital between 1 st October 2015 and 30 th September 2016 was conducted. The predictors were selected using "Sign OK" selection. The risk scoring system was developed according to the seven steps of clinical prediction model development of Steyerberg. Results: This form included eight predictors: maternal age of 35 years old or above, gestational age over 40 weeks, being nulliparous, history of curettage in prior pregnancy, gestational hypertensive disorder, hemoglobin level equal to or less than 10 g/dL, fundal height of 38 centimeters or above, and the use of pethidine for pain relief in the 1st stage of labor. The sensitivity of predicting postpartum blood loss over 300 mL after vaginal delivery by the risk scoring system was 80.7%, specificity of 60.8%, and the ROC curve was equal to 0.71 at the optimal cutoff score of four points or above. To predict the postpartum blood loss of 500 mL or above after vaginal delivery, the sensitivity was 88.1%, specificity of 54.6%, and the ROC curve was equal to 0.71 at the optimal cutoff score of three points or above. Conclusion: This form had an acceptable performance in predicting postpartum blood loss over 300 mL and 500 mL at the optimal cutoff scores of four points or above and three points or above, respectively.

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Section: Introductionmentioning

confidence: 99%

Risk Scoring System for the Prediction of Postpartum Blood Loss over 300 mL at Chiang Rai Regional Hospital

I-Tuporn¹,

Ratanasiri

Nutravong

et al. 2019

Smj

View full text Add to dashboard Cite

show abstract

“…They also recommended this method as a tool for the diagnosis of PPH. 12 In December 2016, the Royal College of Obstetricians and Gynaecologists (RCOG) released a new guideline relative to the prevention and management of PPH. They also confirmed the underestimation of postpartum hemorrhage by the visual estimation method and suggested the use of more reliable methods, including blood collecting drapes or the weighing of soaked swabs after vaginal delivery.…”

Section: Discussionmentioning

confidence: 99%

Incidence and Pregnancy Outcomes of Primary Postpartum Hemorrhage Following Implementation of Postpartum Drape with a Calibrated Bag after Normal Vaginal Delivery

Limsiri

2020

SMJ

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Objective: To evaluate the incidence, risk factors, and pregnancy outcomes of primary postpartum hemorrhage (PPH) after the implementation of postpartum drape with a calibrated bag (PDCB) after normal vaginal delivery. Methods: This retrospective chart review compared patients who had normal vaginal delivery in June 2012 prior to PDCB implementation with patients who had normal vaginal delivery in June 2014 after PDCB implementation at Siriraj Hospital. Results: In total, 856 patients were included in this study, with 458 and 398 patients delivered in June 2012 and June 2014, respectively. Baseline characteristics were comparable between the two groups. The incidence of primary PPH increased significantly after the implementation of PDCB (2.8% in 2012 vs. 8.5% in 2014; p < 0.01). The incidence of severe PPH was also significantly increased (0.4% in 2012 vs. 2.3% in 2014; p = 0.02). Uterine atony was the most common cause and the diagnosis increased after PCDB implementation. The use of additional uterotonic drugs was also significantly increased after PDCB implementation (30.8% in 2012 vs. 85.3% in 2014; p < 0.01). The blood transfusion rate was comparable between the two groups. No peripartum hysterectomy or ICU admission was observed in this study. After PDCB implementation, pregnancy-induced hypertension was found to be a significant risk factor for primary PPH (p < 0.01). Conclusion: The incidence of primary and severe PPH, and the rate of the use of additional uterotonic drugs were all significantly increased after the implementation of PDCB. Pregnancy-induced hypertension was found to be a significant risk factor for primary PPH.

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“…For these two large trials, the fit was also very good. We have also fitted a lognormal distribution to blood loss data using the reported percentiles from an observational study [ 11 ]. In all cases, we have found empirical evidence that the blood loss volume has a lognormal distribution, and can be described by a variant of this family of distributions, the threshold three-parameter lognormal distribution [ 12 ].…”

Section: Discussionmentioning

confidence: 99%

“…We have shown empirically, elsewhere [ 4 ], that the distribution of postpartum blood loss volume is lognormal, using data provided by the authors from three trials that compared two drugs [ 1 , 9 ] or two management procedures for the third stage of labour [ 10 ], and one observational study [ 11 ]. We used this finding to propose an analysis approach based on the lognormal distribution, resulting in more efficient estimates of proportions and relative risk and in a reduction of the sample size needed in clinical trials that compare proportions between treatments [ 4 ].…”

Section: Introductionmentioning

confidence: 99%

Prevention of postpartum haemorrhage: a distributional approach for analysis

2018

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BackgroundThere is empirical evidence that measured postpartum blood loss has a lognormal distribution. This feature can be used to analyze events of the type ‘blood loss greater than a certain cutoff point’ using a lognormal approach, which takes into account all the quantitative observations, as opposed to dichotomizing the variable blood loss volume into two categories. This lognormal approach uses all the information contained in the data and is expected to provide more efficient estimates of proportions and relative risk when comparing treatments to prevent postpartum haemorrhage. As a consequence, sample size can be reduced in clinical trials, while keeping the statistical precision requirements.MethodsThe authors illustrate how a lognormal approach can be used in this situation, using data from a clinical trial and the event ‘blood loss greater than 1000 mL’.ResultsEstimates of the proportions of this event for each treatment, and relative risks obtained with this method are presented and compared with the standard estimates obtained by dichotomizing measured blood loss volume. An example of how the blood loss distributions of two treatments can be compared is also presented. Different scenarios of the sample size needed to compare two treatments or interventions are presented to illustrate how with the lognormal approach the size of a clinical trial can be reduced.ConclusionsA distributional approach for postpartum blood loss using the lognormal distribution fitted to the data results in more precise estimates of risks of events and relative risks, compared to the use of binomial proportions of events. It also results in reduced required sample size for clinical trials.Trial registrationThis paper reports a secondary analysis for a trial that was registered at clinicaltrials.gov (NCT00781066).

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Evaluation of measured postpartum blood loss after vaginal delivery using a collector bag in relation to postpartum hemorrhage management strategies: a prospective observational study

Abstract: This study suggests that PPH incidence may be higher than indicated by population-based data. Underbuttocks drapes are simple, objective bedside tools to diagnose PPH. Blood loss should be quantified systematically if PPH is suspected.

Cited by 16 publications

References 21 publications

Risk Scoring System for the Prediction of Postpartum Blood Loss over 300 mL at Chiang Rai Regional Hospital

Risk Scoring System for the Prediction of Postpartum Blood Loss over 300 mL at Chiang Rai Regional Hospital

Incidence and Pregnancy Outcomes of Primary Postpartum Hemorrhage Following Implementation of Postpartum Drape with a Calibrated Bag after Normal Vaginal Delivery

Prevention of postpartum haemorrhage: a distributional approach for analysis

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