Validation of a quantitative system for real-time measurement of postpartum blood loss

Kahr, Maike; Brun, Reto; Zimmermann, Roland; Franke, Denise; Haslinger, Christian

doi:10.1007/s00404-018-4896-0

Cited by 37 publications

(37 citation statements)

References 19 publications

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“…Our institution uses a proprietary, validated quantitative system to measure vaginal delivery blood loss 21,22 . Immediately after clamping the cord, the midwife places a fresh drape under the woman's pelvis to collect blood.…”

Section: Methodsmentioning

confidence: 99%

“…The drape is regularly checked and if continued bleeding is observed, the drape is weighed on a neonatal balance installed in every suite. If the overall weight (ie, fluid minus drape) exceeds 300 g, a plastic bag with a quantitative scale is placed under the pelvis for blood collection and exact measurement 21,22 . Cesarean blood loss is estimated by the obstetrician; all fluid between hysterotomy and clamping the cord is collected in a pouch and presumed to be mostly amniotic in origin.…”

Section: Methodsmentioning

confidence: 99%

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The impact of prepartum factor XIII activity on postpartum blood loss

Haslinger

Korte

Hothorn

et al. 2020

Journal of Thrombosis and Haemostasis

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Background Postpartum hemorrhage (PPH), a major cause of maternal mortality, has several known risk factors but frequently occurs unexpectedly. PPH incidence and related maternal morbidity and mortality are rising worldwide. Objective To evaluate the impact of defined prepartum blood coagulation parameters on postpartum blood loss. Methods This single‐center, prospective cohort study analyzed prepartum activities of coagulation factors II and XIII and fibrinogen levels in 1300 women. Blood samples were obtained at labor onset and analyzed only after the last patient had delivered, to prevent a potential treatment bias. Blood loss was quantified using a validated technique. The influence of coagulation factors on measured blood loss was assessed by continuous outcome logistic regression. Results Prepartum factor XIII activity strongly influenced measured blood loss: every one unit (%) increase in prepartum factor XIII was associated with an odds ratio of 1.011 (95% confidence interval, 1.006‐1.015; P < .001) to keep blood loss below any given cut‐off level. For illustration, this suggests that a 30% increase in factor XIII activity increases the odds of not suffering PPH (defined as blood loss ≥500 mL) by 38.9%. This effect remained significant after stratification for the delivery mode, when correcting for other risk factors, and was independent of the statistical model used. Factor II but not fibrinogen had a partially comparable, but much less pronounced, effect. Conclusion In the largest population analyzed for the influence of prepartum coagulation factors on PPH to date, prepartum factor XIII activity had a strong impact on postpartum blood loss across every statistical model and clinical subgroup. Our hypothesis that early replenishment of factor XIII levels might constitute a new tool in the prevention and effective early treatment of PPH should be evaluated in future trials.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

The impact of prepartum factor XIII activity on postpartum blood loss

Haslinger

Korte

Hothorn

et al. 2020

Journal of Thrombosis and Haemostasis

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“…QBL measurement was defined as the combined blood loss from all gravimetric and volumetric sources and was continued until the treating clinicians were confident that abnormal bleeding had stopped. The gravimetric technique included weighing all blood soaked swabs and under-buttocks incontinence bed pads and subtracting their known dry weight and has been previously described [8,15,20]. At unassisted vaginal delivery, underbuttocks incontinence pads were changed immediately after delivery to discard amniotic fluid, and subsequent fluid on new pads was assumed to be blood and therefore measured.…”

Section: Methodsmentioning

confidence: 99%

“…Quantitative blood loss (QBL) measurement, using gravimetric and volumetric techniques, is more accurate than visual estimation, both in simulations and clinical practice [10,13,15,19,20] and so gives a more representative and reproducible measure of the incidence and severity of PPH, although all methods have shortcomings. It remains unclear, however, whether quantitative measurement is feasible in all clinical settings, after all types of deliveries and outside of routine hours.…”

Section: Introductionmentioning

confidence: 99%

Incidence of postpartum haemorrhage defined by quantitative blood loss measurement: a national cohort

Bell

Watkins

John

et al. 2020

BMC Pregnancy Childbirth

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Background: Visual estimation of blood loss following delivery often under-reports actual bleed volume. To improve accuracy, quantitative blood loss measurement was introduced for all births in the 12 hospitals providing maternity care in Wales. This intervention was incorporated into a quality improvement programme (Obstetric Bleeding Strategy for Wales, OBS Cymru). We report the incidence of postpartum haemorrhage in Wales over a 1year period using quantitative measurement. Methods: This prospective, consecutive cohort included all 31,341 women giving birth in Wales in 2017. Standardised training was cascaded to maternity staff in all 12 hospitals in Wales. The training comprised mockscenarios, a video and team drills. Uptake of quantitative blood loss measurement was audited at each centre. Data on postpartum haemorrhage of > 1000 mL were collected and analysed according to mode of delivery. Data on blood loss for all maternities was from the NHS Wales Informatics Service. Results: Biannual audit data demonstrated an increase in quantitative measurement from 52.1 to 87.8% (P < 0.001). The incidence (95% confidence intervals, CI) of postpartum haemorrhage of > 1000 mL, > 1500 mL and > 2000 mL was 8.6% (8.3 to 8.9), 3.3% (3.1 to 3.5) and 1.3% (1.2 to 1.4), respectively compared to 5%, 2% and 0.8% in the year before OBS Cymru. The incidence (95% CI) of bleeds of > 1000 mL was similar across the 12 hospitals despite widely varied size, staffing levels and case mix, median (25th to 75th centile) 8.6% (7.8-9.6). The incidence of PPH varied with mode of delivery and was mean (95% CI) 4.9% (4.6-5.2) for unassisted vaginal deliveries, 18.4 (17.1-19.8) for instrumental vaginal deliveries, 8.5 (7.7-9.4) for elective caesarean section and 19.8 (18.6-21.0) for non-elective caesarean sections. Conclusions: Quantitative measurement of blood loss is feasible in all hospitals providing maternity care and is associated with detection of higher rates of postpartum haemorrhage. These results have implications for the definition of abnormal blood loss after childbirth and for management and research of postpartum haemorrhage.

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“…Several studies have reported overestimations of blood loss at low volumes and underestimations at high volumes after vaginal delivery using visual estimation methods [13]. Currently, there are no reliable tools to measure the amount of postpartum blood loss [10,14,15]. Tourne et al used a plastic bag to collect and measure the volume of blood loss after delivery and investigated the correlation between the bag's volume and hemoglobin and hematocrit levels.…”

Section: Discussionmentioning

confidence: 99%

Measurement of Postpartum Blood Loss Using a New Two - Set Liquid Collection Bag for Vaginal Delivery: A Prospective, Randomized, Case Control Study

Wang

Weng

et al. 2020

Preprint

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Background Postpartum hemorrhage (PPH) is a major obstetric complication, and the real-time measurement of blood loss is important in the management and treatment of PPH. We designed a new two-set liquid collection bag (TSLCB) for measuring postpartum blood loss in vaginal delivery. The aim of this study was to evaluate the effectiveness of the TSLCB in separating the blood from the amniotic fluid during vaginal delivery and in determining the accuracy of the measured postpartum blood loss.Methods A prospective, randomized, case control study was conducted in the Women’s Hospital, Zhejiang University School of Medicine, from March 2018 to April 2018. Sixty single pregnant women with spontaneous labor at 37–41 weeks without maternal complications were randomly divided into the experimental and control groups. The TSLCB was used to evaluate separately the amount of blood and amniotic fluid. For the control group, visual estimation and traditional plastic blood-collecting consumables were used to estimate the amount of postpartum blood loss. The measured blood loss between the two groups was compared, and the association of the measured blood loss with various clinical lab indices and vital signs was investigated. Results The TSLCB (the experimental group) improved the detection of the measured blood loss compared with visual estimation and the traditional method (the control group) (p < 0.05). In the experimental group, correlation analysis showed that the measured blood loss at delivery and within 24 h of delivery was significantly associated with the decreased hemoglobin level, red blood cell count, and hematocrit level of patients (r = -0.574, -0.455, -0.437; r = 0.-595, -0.368, -0.374; p < 0.05). In the control group, only the measured blood loss within 24 h of delivery was associated with the decreased hemoglobin level (r = -0.395, p < 0.05). No blood transfusion and plasma expanders were required in the treatment of PPH for both groups.Conclusions The TSLCB can be used to accurately measure the postpartum blood loss in vaginal delivery by medical personnel.Trial registration: This trial was registered with Chinese Clinical Trial Registry (ChiCTR): ChiCTR-IOR-17012453, 23 August 2017.

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Validation of a quantitative system for real-time measurement of postpartum blood loss

Abstract: The technique of real-time measurement of postpartum blood loss after vaginal delivery as presented in this study is practicable, reliable and strongly correlated with the actual blood loss and, therefore, poses an actual improvement in the management of PPH.

Cited by 37 publications

References 19 publications

The impact of prepartum factor XIII activity on postpartum blood loss

The impact of prepartum factor XIII activity on postpartum blood loss

Incidence of postpartum haemorrhage defined by quantitative blood loss measurement: a national cohort

Measurement of Postpartum Blood Loss Using a New Two - Set Liquid Collection Bag for Vaginal Delivery: A Prospective, Randomized, Case Control Study

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