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Accuracy of Blood Loss Measurement During Cesarean Deliveries
Abstract Number: GM-05
Abstract Type: Original Research
Background: Postpartum hemorrhage (PPH) is a major cause of maternal morbidity and mortality. Standardized approaches to the recognition and treatment of PPH based on an accurate estimation of blood loss are recommended.(1) Of the currently available methods used to determine intraoperative blood loss during cesarean deliveries, visual estimation is inaccurate, underestimating blood loss by up to 41% (2) and the often recommended quantitative gravimetric method is also inaccurate, time consuming and difficult to implement.(3) A novel colorimetric method (Triton System™, Gauss Surgical, Los Altos, CA) uses image processing algorithms to measure blood loss by photographing surgical sponges and suction canisters and calculating their hemoglobin content independent of contamination with amniotic or other fluids.
Objective: To compare the accuracy of a visual, quantitative gravimetric and the novel colorimetric method in determining blood loss during cesarean deliveries.
Study Design: Fifty patients having cesarean deliveries had blood loss determined by obstetricians’ visual estimates, a quantitative gravimetric method, the colorimetric system and by assay of hemoglobin content from surgical sponges and in suction canisters. Agreement between the hemoglobin extraction assay (reference standard) and other measures was evaluated using the Bland-Altman method.
Results: Compared to the blood loss measured by the assay (470±296 ml), the colorimetric system (572±334 ml) was more accurate than either visual estimation (928±261 ml) or gravimetric measurement (822±489 ml). The correlation between the hemoglobin assay method and the colorimetric system was more predictive (standardized coefficient = 0.951, adjusted R2 = 0.902) than either visual estimation (standardized coefficient = 0.700, adjusted R2 = 0.479) or the gravimetric determination (standardized coefficient = 0.564, adjusted R2 = 0.304) (Figure).
Conclusion: Measuring blood loss using colorimetric image analysis during cesarean delivery is more accurate than both visual estimation and gravimetric methods. Implementation of the colorimetric system may facilitate the accurate recognition of blood loss potentially improving patient safety and clinical outcomes. Further studies of this method and the associated outcomes are needed.
1. Anesth Analg 2015;121:142-148
2. Anesth Analg. 2007;105:1736-40
3. J Gynecol Surg 1993;9:151