Impact of measuring quantification of blood loss versus estimation of blood loss during cesarean deliveries

Abstract

Postpartum hemorrhage (PPH) is the leading cause of maternal morbidity and mortality, accounting for 27% of maternal deaths worldwide. 1 Studies have suggested that under-resuscitation and delayed intervention are the main causes of maternal death from hemorrhage. 2 Inaccurate estimation of blood loss is likely the most common reason for lack of recognition of severity of blood loss and delay in treatment. Visual estimation of blood loss (EBL) has been extensively studied and has consistently been shown to be inaccurate, regardless of provider education or seniority. 3 EBL leads to an underestimation of the amount of blood lost, [3][4][5][6] especially in volumes greater than 1000 ml. 7 Blood loss of under 1000 ml results in overestimation, when compared with measured volume. 8 Both overestimation and underestimation of blood loss can cause harm, and early detection and intervention remains a challenge in managing PPH. 9Quantification of blood loss (QBL) is an objective method used to evaluate bleeding utilizing standardized measurable weight and scale-based techniques. This method has been shown to be more accurate than visual estimation of blood loss. 10,11 Graduated vaginal delivery drapes had an error rate of less than 15% when properly

Postpartum haemorrhage in high‐resource settings: Variations in clinical management and future research directions based on a comparative study of national guidelines

“…Moreover, measuring blood loss can be time-consuming, contributing to delays in PPH management. [34][35][36] The addition of clinical parameters may provide an earlier warning of (severity) of PPH. 35 Variations as to when to start blood loss quantification may contribute to differences in the incidence of (severe) PPH among countries highlighting the need for consensus.…”

“…Although measurements seem to be more accurate than visual estimation alone, no difference has been reported in terms of maternal outcome. Moreover, measuring blood loss can be time‐consuming, contributing to delays in PPH management 34‐36 . The addition of clinical parameters may provide an earlier warning of (severity) of PPH 35 .…”