Observer accuracy and reproducibility of visual estimation of blood loss in obstetrics: how accurate and consistent are health-care professionals?

Yoong, Wai; Karavolos, Stamatios; Damodaram, Mellisa; Madgwick, Karen; Milestone, N.; Al-Habib, Ansam; Fakokunde, A.; Okolo, Stanley

doi:10.1007/s00404-009-1099-8

Cited by 94 publications

(58 citation statements)

References 12 publications

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“…(10)(11)(12)(13) Previous studies have reported that, independent of the experience or skill level of healthcare providers, visual estimation of postpartum blood loss has a 25%-89% error of measurement. (5,6,9,14) The present study supports these findings. Similarly, a study by Prasertcharoensuk et al (9) reported error of measurement using visual estimation as compared with direct measurement; however, details of the direct measurement protocol was not explained.…”

Section: Discussionsupporting

confidence: 91%

Postpartum blood loss: visual estimation versus objective quantification with a novel birthing drape

Lertbunnaphong

Lapthanapat

Leetheeragul

et al. 2015

smedj

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INTRODUCTIONImmediate postpartum haemorrhage (PPH) is defined as blood loss ≥ 500 mL after normal vaginal delivery.(1-3) This obstetric complication is a leading cause of maternal death worldwide. To prevent the occurrence of PPH, current evidence supports active management of the third stage of labour, especially the prescription of oxytocin, as standard obstetric care.(1-3) However, the optimal method for determining the volume of postpartum blood loss for early detection of PPH remains unclear.Although the ideal measurement of postpartum blood loss involves the use of objective tools, visual estimation is still commonly used in daily obstetric practice.(4) Photospectometry is the gold standard blood loss measurement technique due to its accuracy. However, this technique is complicated, costly and impractical. Additionally, photospectrometry cannot be applied at all levels of healthcare and is more suitable for clinical research.(4,5) In a previous study, an alternative method weighed soaked swabs or drapes after delivery, which proved to be effective for the early detection of PPH.(6) However, this method substantially increases the workload of medical staff members and may not be suitable in a busy hospital setting.The use of sterile under-buttock or postpartum drapes is another method of postpartum blood loss measurement. This method is suitable for low-resource hospitals, as it is inexpensive, convenient and easy to use. Previous studies have shown that it produced results that highly correlated with those of standard photospectrometry (correlation coefficient [r] = 0.93), with a reduction in postpartum haemoglobin levels reported. (5,7,8) Therefore, this method was chosen as the gold standard in the present study.The purpose of this study was to compare the efficacy of visual estimation and objective measurement using the sterile under-buttock drape to determine the volume of postpartum blood loss in PPH. We hope that the results of this study will lead to improvements in standard obstetric care for the early detection of immediate PPH. METHODSWith the ethical approval of the Siriraj Institutional Review Board, the present study was prospectively conducted from June 2013 to December 2013. Pregnant Thai women aged ≥ 18 years who were admitted in the early phase of labour were included in the study. Women who had painful contractions, were near delivery, or were under the sedative effect of morphine or its derivatives were excluded. This study also excluded women who had bleeding disorders (e.g. idiopathic thrombocytopenic purpura), dependence on bleeding-related medication (e.g. aspirin), a Caesarean delivery, fetal anomalies or a stillbirth. All the

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Section: Discussionsupporting

confidence: 91%

Postpartum blood loss: visual estimation versus objective quantification with a novel birthing drape

Lertbunnaphong

Lapthanapat

Leetheeragul

et al. 2015

smedj

View full text Add to dashboard Cite

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“…It is known that without a quantitative measurement method, blood loss is often underestimated. 15,16 The calculation of DHb by measurement before and after delivery poses an objective variable to examine blood loss during birth. Because it is routine in our institution to determine Hb levels in all parturient women before as well as after delivery, no woman with intrahepatic cholestasis of pregnancy and only 15 women in the control group were excluded from analysis as a result of missing DHb.…”

Section: Discussionmentioning

confidence: 99%

Postpartum Blood Loss in Women Treated for Intrahepatic Cholestasis of Pregnancy

Furrer

Winter

Schäffer

et al. 2016

Obstetrics &Amp; Gynecology

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OBJECTIVE To evaluate postpartum blood loss in women with treated intrahepatic cholestasis of pregnancy. METHODS In a retrospective case-control study, 15,083 deliveries including 348 women with intrahepatic cholestasis of pregnancy (2.3%) were analyzed from 2004 to 2014. To adjust for differences in baseline characteristics, a propensity analysis was performed and women in the control group were matched to the women in the intrahepatic cholestasis of pregnancy group in a 5:1 ratio. , meconium staining (14.5% compared with 11.4%, P=.12), and number of stillbirths after 26 weeks of gestation (0.6% compared with 1.8%, P=.10) were not significantly different in the study compared with the control group. In moderate and severe intrahepatic cholestasis of pregnancy, meconium staining was observed significantly more often compared with that in a control group (23.0% and 32.3% compared with 11.4%, P<.01). There was no correlation between estimated blood loss or ΔHb and severity of intrahepatic cholestasis of pregnancy. CONCLUSIONS In our cohort of women with intrahepatic cholestasis of pregnancy who are treated with ursodeoxycholic acid and have planned delivery (induction of labor or planned cesarean delivery) at 38 weeks of gestation, no differences in postpartum blood loss were seen.

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“…Previous studies, investigating the accuracy of the estimation of blood loss during surgery, have shown that such estimations are plagued by a high degree of inaccuracy, with a predominant underestimation [3,[20][21][22]. A potential explanation for Fig.…”

Section: Discussionmentioning

confidence: 95%

Estimate or calculate? How surgeons rate volumes and surfaces

Schuld

Kollmar

Seidel

et al. 2012

Langenbecks Arch Surg

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We found a large bias in estimating the dimension of both commonly used objects and the surface area of liver parenchyma transection. Obviously, estimating errors are more influenced by the individual subject who estimates than by the object itself. In clinical routine, surgeons should rely more on simple measuring devices than on their own sense of proportion. Education in how to estimate more correctly human liver resection surfaces can be achieved by ex vivo studies using porcine livers.

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Observer accuracy and reproducibility of visual estimation of blood loss in obstetrics: how accurate and consistent are health-care professionals?

Abstract: Visual estimations were inaccurate by health-care professionals who have a tendency to overestimate. Experience did not appear to have a confounding effect on accuracy. Further training in visual assessment skills is necessary in order to improve the clinicians' estimation.

Cited by 94 publications

References 12 publications

Postpartum blood loss: visual estimation versus objective quantification with a novel birthing drape

Postpartum blood loss: visual estimation versus objective quantification with a novel birthing drape

Postpartum Blood Loss in Women Treated for Intrahepatic Cholestasis of Pregnancy

Estimate or calculate? How surgeons rate volumes and surfaces

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