Development and Assessment of Pictorial Guide for Improved Accuracy of Visual Blood Loss Estimation in Cesarean Delivery.

Abstract

Estimated blood loss for surgical procedures performed via visual estimation is known to be an inaccurate method. Blood loss estimation is further complicated during cesarean delivery (CD) by a large volume loss for a short period as well as the presence of amniotic fluid. We hypothesized that a pictorial guide depicting premeasured blood volumes and materials commonly used in a CD would improve clinician accuracy in estimated blood loss. A simulated CD scene was used to assess the ability of clinicians to estimate the amount of blood lost by a CD patient. Accuracy of the estimates was assessed before and after they had access to the pictorial guide created for the study. Before the intervention, 52% of participants estimated more than 25% above or below actual blood loss volume. With use of the guide, clinicians became more accurate at blood loss estimation. After the intervention, the number of participants estimating within 5% of the actual volume increased from 7% before to 24% (P = 0.033). An institution-specific pictorial guide is effective at improving the accuracy of visual blood loss estimation in a simulation and may help improve clinical care in CD.