Radioisotope Dilution Technique for Measurement of Blood Loss Associated With Lower Segment Caesarean Section

Read, M. D.; Anderton, J. M.

doi:10.1111/j.1471-0528.1977.tb12508.x

Cited by 12 publications

(10 citation statements)

References 11 publications

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“…Significant underestimation in the volumes of large floor spillage, large surgical swab capacity and massive PPH was demonstrated by this study. Previous studies confirm that blood loss at vaginal delivery are underestimated by -35% (EBL = 260 ml versus ABL = 401 ml) 3 and that mean ABL at a first caesarean section is in fact 1290 ± 240 ml, 13 significantly more than the EBL recorded by most obstetricians.…”

Section: Discussionmentioning

confidence: 90%

“…9 Accurate visual estimation of cumulative blood loss forewarns of impending haemorrhagic shock. Estimates of blood loss by paramedics 10 and surgeons 11 are inaccurate, and studies following vaginal 12 and abdominal delivery 13 show visual estimation to be of limited clinical use. Menstrual pictograms to facilitate the assessment of menorrhagia in the field of gynaecology 14 have now been produced; however, little pictorial data yet exist to facilitate similar estimations of blood loss in obstetrics.…”

Section: Introductionmentioning

confidence: 99%

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Improving the accuracy of estimated blood loss at obstetric haemorrhage using clinical reconstructions

Bose¹,

Regan

Paterson‐Brown³

2006

BJOG

344

218

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Objectives Following the results of the Confidential Enquiries into Maternal Deaths report, which claims two maternal deaths annually in the UK from postpartum haemorrhage, our aim was to assess the accuracy of ‘visual estimation of blood loss’ and produce suitable pictorial and written algorithms to aid in the recognition and management of massive obstetric haemorrhage. Design Observational study to determine discrepancy between actual blood loss (ABL) and estimated blood loss (EBL). Setting Teaching hospital. Population Hundred and three obstetricians, anaesthetists, midwives, nurses and healthcare assistants. Methods Clinical scenarios were reproduced in the form of 12 Objective Structured Clinical Examination (OSCE) style stations augmented with known volumes of whole blood. Individual staff estimated the blood loss visually and recorded their results. Digital photographs were used to produce a pictorial ‘algorithm’ suitable for use as a teaching tool in labour ward. Main outcome measures Areas of greatest discrepancy between EBL and ABL. Results Significant underestimation of the ABL occurred in 5 of the 12 OSCE stations: 500‐ml (50‐cm diameter) floor spill, 1000‐ml (75‐cm diameter) floor spill, 1500‐ml (100‐cm diameter) floor spill, 350‐ml capacity of soaked 45‐ × 45‐cm large swab and the 2‐l vaginal postpartum haemorrhage on bed/floor. Conclusions Accurate visual estimation of blood loss is known to facilitate timely resuscitation, minimising the risk of disseminated intravascular coagulation and reducing the severity of haemorrhagic shock. Participation in clinical reconstructions may encourage early diagnosis and prompt treatment of postpartum haemorrhage. Written and pictorial guidelines may help all staff working in labour wards.

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Section: Discussionmentioning

confidence: 90%

Section: Introductionmentioning

confidence: 99%

Improving the accuracy of estimated blood loss at obstetric haemorrhage using clinical reconstructions

Bose¹,

Regan

Paterson‐Brown³

2006

BJOG

344

218

View full text Add to dashboard Cite

show abstract

“…Another study showed that up to 16% of vaginal and 30% of operative vaginal deliveries may be associated with blood loss greater than 500ml (23). Using radioisotope dilution techniques, the mean blood loss for first elective cesarean section was found to be 1 290 (±240ml), which is significantly more than the estimated blood loss recorded by most obstetricians (24).…”

Section: Definitions Of Pph and Related Problemsmentioning

confidence: 94%

Postpartum hemorrhage - update on problems of definitions and diagnosis*

Rath

2011

Acta Obstetricia Et Gynecologica Scandinavica

191

120

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Maternal mortality due to postpartum hemorrhage (PPH) continues to be one of the most important causes of maternal death worldwide. PPH is a significantly underestimated obstetric problem, primarily because a lack of definition and diagnosis. The 'traditional' definition of primary PPH based on quantification of blood loss has several limitations. Notoriously, blood loss is not measured or is significantly underestimated by visual estimation and there are no generally accepted cut-offs limits for estimated blood loss. A definition based on hematocrit change is not clinically useful in an emergency such as PPH, as a fall in hematocrit postpartum shows poor correlation with acute blood loss. The need for erythrocyte transfusion alone to define PPH is also of limited value, as the practice of blood transfusion varies widely. Definitions based on symptoms of hemodynamic instability are problematic, as they are late signs of depleted blood volume and commencing failure of compensatory mechanisms threatening the mother's life. There is thus currently no single, satisfactory definition of primary PPH. Proper and timely diagnosis of PPH should above all include accurate estimation of blood loss before vital signs change. Estimation of blood loss by calibrated bags has been shown to be significantly more accurate than visual estimation at vaginal delivery. Careful monitoring of the mother's vital signs, laboratory tests, in particular coagulation testing, and immediate diagnosis of the cause of PPH are important key factors to reduce maternal morbidity and mortality.

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“…Caesarean section is one of the factors related to postpartum haemorrhage as Read et al reported that the mean blood loss ( S D ) was 1,290 (k240) mL for first Caesarean section and 1,012 (*380) mL for repeat operations (8). The presence of an episiotomy or perineal laceration is also important for patients delivered vaginally: Paul1 and Ratten (9) reported that, in both nulliparas and multiparas, the amount of blood loss more than doubled in patients with a laceration or episiotomy in comparison with those with an intact perineum.…”

Section: Discussionmentioning

confidence: 99%

How Well Does Epidemiological Evidence Hold For The Relationship Between Smoking and Adverse Obstetric Outcomes in New South Wales?

P.L

Bauman

1997

Aust NZ J Obst Gynaeco

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This study examines whether the established epidemiological relationship between cigarette-smoking exposure in pregnancy and adverse obstetric outcomes are confirmed in Australian data from the NSW Midwives Data Collection (MDC). These data were analysed to compare the obstetric complications and pregnancy outcomes between smoking and nonsmoking women confined in 1994. Results showed that smoking mothers had higher rates of antepartum haemorrhage due to placental abruption and placenta praevia. They were also at higher risk of giving birth to low birth-weight babies and preterm delivery. Infants born to smoking mothers were 17% more likely to be admitted to hospital special care nurseries or neonatal intensive care units. Moreover, the risk of reported perinatal death among babies of smoking mothers was 20% higher than babies of nonsmoking mothers. However, smoking during pregnancy was found to confer a protective effect against the development of pregnancy-induced hypertension. These results were compared with existing evidence from the literature. Published research reports on the corresponding smoking effects were identified to assess the consistency of evidence and typical risk ratios. Findings from the literature search showed a near-perfect concordance with the associations in the NSW MDC data. The paper documents the likely complications which might be prevented if smoking in pregnancy were eliminated. There remains a real need for effective programmes to reduce smoking prevalence in pregnancy.

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Radioisotope Dilution Technique for Measurement of Blood Loss Associated With Lower Segment Caesarean Section

Cited by 12 publications

References 11 publications

Improving the accuracy of estimated blood loss at obstetric haemorrhage using clinical reconstructions

Improving the accuracy of estimated blood loss at obstetric haemorrhage using clinical reconstructions

Postpartum hemorrhage - update on problems of definitions and diagnosis*

How Well Does Epidemiological Evidence Hold For The Relationship Between Smoking and Adverse Obstetric Outcomes in New South Wales?

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