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Impact of Quantitative Blood Loss on Postpartum Hemorrhage Protocol Activation and Resource Utilization
Abstract Number: F3B-423
Abstract Type: Original Research
Postpartum hemorrhage (PPH) is a leading cause of maternal morbidity and mortality. Visual estimation of blood loss (EBL) is often inaccurate, and overestimation may result in inappropriate resource utilization. As accurate identification of blood loss may improve early recognition of PPH, several organizations have called for quantitative blood loss (QBL). The objective of this study was to determine if QBL measurement would result in fewer PPH protocol activations than visual EBL. A secondary objective was estimation of potential cost-savings of resources utilized in PPH management. We hypothesized that QBL estimates would result in a 30% reduction in the number of PPHs.
In this IRB-approved prospective observational trial, blood loss was estimated using the Gauss Triton System for 42 parturients who experienced PPH during cesarean delivery (1 liter by EBL assessment). The Gauss system uses a scale to measure clots and a tablet to capture images of surgical laps and suction canisters and uses a cloud-based algorithm to calculate blood loss. Clinicians were blinded to QBL measurements. Demographic, obstetric, medical and surgical data were collected, as well as resources mobilized in the PPH. Cost data were estimated using information available in the literature.
Twenty-four patients (57%) would not have been classified as having PPH with QBL compared to EBL. The difference in median blood loss between QBL and EBL was 326 mL. Table 1 shows the interventions received by the patients who would not have been classified as PPH by QBL. Using the assumption that 100% of the resources would not have been utilized assuming QBL measurements, total cost-savings would be $2950. As a sensitivity analysis, given some resources may have been employed based on the clinical status of the patient, a 50% reduction in use would result in a cost-savings of $1475.
The important finding of this study is that QBL would have reduced patients classified as having PPH by EBL by over 50%. This represents a potential cost-savings of $2950, and reduced exposure to uterotonics and improved patient satisfaction from unnecessary interventions. One limitation is that the QBL measurements occurred after the CD and were not performed in real time. Future work should evaluate real-time assessment of QBL and impact on patient outcomes.
1. Main E et al. Anesth Analg 2015;121:142–8
2. Kent et al. In: SOAP 50th Annual Meeting; 2018; Miami, FL.