Accuracy of Blood Loss Estimation After Vaginal Delivery

2014-08-27 03:39:02 | BioPortfolio


Post-partum hemorrhage (PPH) is defined as blood loss greater than 500 mL after vaginal delivery (1). Delayed diagnosis of PPH is a major cause of maternal morbidity and mortality (2). Obstetricians estimate blood loss at delivery by visual estimation of blood collected in the obstetric drapes. Blood is often mixed with urine and surgical sponges. The urine, blood and sponges collect in a cone shaped plastic bag that is suspended from the perineum during delivery.Visual estimation of blood loss is insensitive in diagnosing PPH. In one study visual assessment of blood loss underestimated postpartum blood loss by 33% to 50% compared to an objective measurement of blood loss using photospectrometry (3). Other studies have shown that the magnitude of underestimation increases as the amount of blood loss is increased (4). A limitation of previous studies is that there is no "gold standard" for blood loss determination in the third stage of labor. Care providers (obstetricians, anesthesiologist, and labor & delivery nurses) need to be able to accurately estimate blood loss in order to better care for mothers and prevent morbidity and mortality. It is unknown whether provider type or experience (obstetric and anesthesiology resident, fellow, and attending physicians, and nurses) influences the accuracy of blood loss estimation, or whether blood loss estimation can be improved by providing graduated markings on the vaginal delivery drape.


Packed red blood cells discarded by the Blood Bank will be mixed with normal saline to simulate blood with a hematocrit of 33. A total of eight isolated study stations will be set up (study participants will only be able to visualize the vaginal delivery drape for one station at a time). The simulated blood will be mixed with urine and sponges (see Table) and be placed in suspended blood collection drapes which are used during vaginal deliveries at Northwestern Memorial Hospital. Two types of drapes will be used: drapes without calibrated markings and drapes with calibrated markings. Calibrated volume markings will begin at 500 mL at 500 mL intervals to 2500 mL.

Study participants will be randomized to one of two groups. Randomization will occur in blocks depending on provider type. Group one will view the unmarked vaginal collection drapes first and the Group 2 will view the collection drapes with the calibrated markings first. Both groups will analyze the 4 study stations in random order. At the completion of the 4 study stations, the group which analyzed the drapes without markings will cross over to view the stations with calibrated markings and vice versa.

Each study participant will view a station and write his/her estimation of blood loss on a data card. Study participants will NOT be allowed to change answers once they have been recorded.

The study stations will be set up in for an 8-12 hour period in an empty Labor and Delivery Room (LDR) at PWH at a time that is convenient for the Labor and Delivery Unit and the investigators. At the end of the study, the blood mixtures will be disposed of in accordance with safe handling of biohazardous material.

Demographic data on study participants will include provider type, level of training/years of practice, and gender.

Study Design

Time Perspective: Prospective




blood loss estimation


Northwestern University
United States




Northwestern University

Results (where available)

View Results


Published on BioPortfolio: 2014-08-27T03:39:02-0400

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Medical and Biotech [MESH] Definitions

Excess blood loss from uterine bleeding associated with OBSTETRIC LABOR or CHILDBIRTH. It is defined as blood loss greater than 500 ml or of the amount that adversely affects the maternal physiology, such as BLOOD PRESSURE and HEMATOCRIT. Postpartum hemorrhage is divided into two categories, immediate (within first 24 hours after birth) or delayed (after 24 hours postpartum).

The sudden loss of blood supply to the PITUITARY GLAND, leading to tissue NECROSIS and loss of function (PANHYPOPITUITARISM). The most common cause is hemorrhage or INFARCTION of a PITUITARY ADENOMA. It can also result from acute hemorrhage into SELLA TURCICA due to HEAD TRAUMA; INTRACRANIAL HYPERTENSION; or other acute effects of central nervous system hemorrhage. Clinical signs include severe HEADACHE; HYPOTENSION; bilateral visual disturbances; UNCONSCIOUSNESS; and COMA.

A single-chain polypeptide derived from bovine tissues consisting of 58 amino-acid residues. It is an inhibitor of proteolytic enzymes including CHYMOTRYPSIN; KALLIKREIN; PLASMIN; and TRYPSIN. It is used in the treatment of HEMORRHAGE associated with raised plasma concentrations of plasmin. It is also used to reduce blood loss and transfusion requirements in patients at high risk of major blood loss during and following open heart surgery with EXTRACORPOREAL CIRCULATION. (Reynolds JEF(Ed): Martindale: The Extra Pharmacopoeia (electronic version). Micromedex, Inc, Englewood, CO, 1995)

Intracranial bleeding into the PUTAMEN, a BASAL GANGLIA nucleus. This is associated with HYPERTENSION and lipohyalinosis of small blood vessels in the putamen. Clinical manifestations vary with the size of hemorrhage, but include HEMIPARESIS; HEADACHE; and alterations of consciousness.

Acute hemorrhage or excessive fluid loss resulting in HYPOVOLEMIA.

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