///2019 Abstract Details
2019 Abstract Details2019-07-13T07:45:15-05:00

Impact of Measuring Quantification of Blood Loss Versus Estimation of Blood Loss on Perioperative Resuscitation During Cesarean Deliveries

Abstract Number: F3H-177
Abstract Type: Original Research

Akshay Bhatt MD1 ; Singh Nair PhD2; Takiyah Mitchell BS3; Meleen Chuang MD4; Shamantha Reddy MD5

Background

Postpartum hemorrhage (PPH) is the leading cause of maternal morbidity and mortality. Delayed recognition of PPH from underestimation of blood loss is the major cause of PPH related maternal death.(1) Visual estimation of blood loss (EBL) is an unreliable measure of postpartum blood loss.(2) Quantification of blood loss (QBL), on the other hand, is an objective weight based technique to calculate blood loss. QBL is especially useful to quantify higher order blood loss compared to EBL.(3) The first aim of this study is to evaluate all cesarean deliveries (CD) at an academic medical center and determine if there is a statistically significant difference between QBL vs. EBL. The second aim is to determine whether the initiation of QBL led to increased recognition and intervention for PPH.

Methods

A retrospective review was conducted of all patients between Oct 2017 and Nov 2018 who underwent CD at an academic medical center. Since May 2018, the protocol for all CD included the documentation of EBL and QBL. Patient charts were reviewed for patient demographics, length of surgical procedure, pre and post-operative hematocrit, EBL, QBL (when documented), indication for CD, and peri-operative packed red blood cell transfusions.

Results

Out of a total of 749 CD, 369 CD had only EBL documented and 380 CD had EBL and QBL documented. The average EBL when documented alone (898cc ± 281cc) was significantly lower than the average EBL when documented with QBL (962cc ± 458cc), P = 0.020. For patients with both EBL and QBL documented, there was no statistically significant difference between the average EBL and the average QBL, P = 0.262. Furthermore, both EBL and QBL were poor predictors of post-operative hematocrit (r² = 0.033 and 0.021, respectively). CD with documented EBL and QBL had a significantly greater number of blood transfusions (40 CD, 9.5%) versus those with only EBL documented (18 CD, 4.9%), P = 0.012.

Conclusions

Our findings suggest that documenting QBL results in higher EBL and more frequent resuscitation with blood products, supporting the idea that quantitative measures may be more accurate in tracking intraoperative blood loss. These findings underscore the importance of integration of QBL into intraoperative evaluation in patients undergoing CD and it merits further study as a predictor of clinical outcomes.

References

1. Berg , Harper M, Atkinson S, Bell E, Brown H, Hage M, Mitra A, Moise K, Callaghan W. Preventability of Pregnancy-Related Deaths: Results of a State-Wide Review. Obstetrics & Gynecology. 106(6). 1228-1234.

2. Al Kadri HM, Al Anazi BK, Tamim HM. Visual estimation versus gravimetric measurement of postpartum blood loss: a prospective cohort study. Arch Gynecol Obstet. 2011 Jun;283(6):1207-13.

3. Lilley G, Burkett-St-Laurent D, Precious E, Bruynseels D, Kaye A, Sanders J, Alikhan R, Collins PW, Hall JE, Collis RE. Measurement of blood loss during postpartum haemorrhage. Int J Obstet Anesth. 2015 Feb;24(1):8-14.

SOAP 2019