882: A comparison of quantified versus estimated blood loss at the time of cesarean delivery

Abstract

To compare the diagnostic accuracy of visual estimation of blood loss (EBL) versus quantified blood loss (QBL) for the targeted outcomes of blood transfusion and hemoglobin (Hgb) drop ≥ 3 gm/dL after cesarean delivery. Comparison of EBL versus QBL in a cohort of women being delivered in a tertiary care facility from July 1, 2017 – July 31, 2018 via scheduled and unscheduled non-emergent cesarean delivery. Maternal/neonatal demographics were collected along with outcome measures to include pre-operative hemoglobin, post-operative hemoglobin, and blood transfusion. EBL versus QBL for identifying postpartum hemorrhage were compared utilizing the area under the ROC curve for the targeted outcomes of blood transfusion and hemoglobin decline of more than 3 grams/dL. From July 1, 2017 – July 31, 2018 there were 994 deliveries with complete data. There were 40 women (4.0%) who received red cell transfusions and 132 (13.3%) who had a post-operative hemoglobin drop of ≥3grams/dL. In the majority of cases (701/995, 70.5%), QBL exceeded EBL. In ROC curve analysis, the area under the curve estimate was 0.67 for QBL vs 0.6 for EBL to predict the need for blood transfusion; this was not statistically significant (difference = 0.074, 95% CI -0.023 - 0.171, p=0.13). The area under the curve estimate was 0.69 for QBL vs 0.646 for EBL to predict post-partum hemoglobin drop of > 3 grams/dL; this was not statistically significant (difference = 0.044, 95% CI -0.011 - 0.100, p=0.12). QBL and EBL perform similarly in scheduled and non-emergent cesarean deliveries for identifying hemorrhage utilizing the target outcomes of blood transfusion and drop in Hgb ≥ 3 gm/dL. Costs and benefits should be considered further before implementing QBL as a standard of care to predict postpartum hemorrhage.View Large Image Figure ViewerDownload Hi-res image Download (PPT)