Accurate Assessment of Blood Loss During Cesarean Delivery Improves Estimate of Postoperative Hemoglobin [17B]

Abstract

INTRODUCTION: The need for red blood cell transfusion for patients having cesarean delivery is ideally based on an evaluation of both clinical indicators and laboratory studies. In practice, transfusions are often given to women based on estimated intraoperative blood loss (EBL) and/or the postoperative hemoglobin level. Since visual estimation is known to be inaccurate, we postulated that a more accurate determination using a novel colorimetric device would be better correlated with postoperative day one hemoglobin than visual estimation. METHODS: A formula incorporating both height and weight was used to estimate blood volume and, by including preoperative hemoglobin, red cell mass. Assuming a constant blood volume either the visual EBL (n=32) or EBL using a novel colorimetric device (Triton System™, Gauss Surgical) that incorporates a mobile application to photograph sponges and canisters and calculate their hemoglobin content (n=53) was used to predict the postoperative day one hemoglobin value in patients where either the visual estimate or colorimetric estimate was >1,000 ml (a common definition of hemorrhage). RESULTS: The predicted postoperative day one hemoglobin level using the device was better correlated with the actual value (R squared=0.319) than the predictions using visual EBL (R squared=0.035) (P=.027). CONCLUSION: In mothers with high blood loss, EBL using the novel device was a more accurate predictor of the postoperative day one hemoglobin than visually estimated blood loss. Clinical use of this information has the potential to improve transfusion practice in cesarean delivery patients and positively impact maternal health.

Anesthesia for Cesarean Section: Retrospective Comparative Study

“…This study did not rely on sophisticated method(s) for EBL, but the method of estimation was unified in all cesareans. In women with high EBL, Rubenstein et al 10 found that using a novel colorimetric device was a more accurate predictor of post-operative hemoglobin. Other authors 11 did not support the view that EBL or quantitative assessment of blood loss (QBL) methods accurately reflect the actual blood loss during scheduled cesarean section.…”

Quantification of Intraoperative Blood Loss in a Simulated Scenario Using a Novel Device

“…The application has already been tested in vitro (10,11) and is capable of measuring Hb with acceptable accuracy in blood samples with a wide range of Hb levels and dilutions (9,12). The application provides real-time information on blood loss and has the potential to improve the management of bleeding patients and hemotherapy (13)(14)(15)(16)(17). To our knowledge, there is no study that directly compares a colorimetric blood loss estimate to the existing clinical practice of visual and gravimetric blood loss estimation in a simulated scenario with known blood volumes as a reference.…”

Visual estimation of blood loss versus quantification of blood loss after vaginal birth using an innovative drape: a prospective study

“…The recently reported use of artificial intelligence (AI) namely Triton too is not feasible in these settings. 5,6 The pragmatic methods of assessing postpartum bleeding are visual estimation of blood loss (EBL) and quantitative assessment of blood loss (QBL) which includes direct collection (volumetric) added to that measured by weighing (gravimetric). EBL still remains the most commonly employed method in clinical practice in spite of various reports of gross underestimation of the actual blood loss by virtue of it being a subjective assessment.…”