Quantitative Blood Loss Measurement

Abstract

INTRODUCTION: Obstetrical hemorrhage is the leading cause of preventable maternal mortality worldwide. Weight-based, quantitative blood loss (QBL) has been proposed as a superior to visual estimation for determining blood loss by several ACOG districts. The objective of this project was: 1) to determine if there was a difference in ability to accurately estimate blood loss at vaginal delivery versus cesarean delivery 2) to determine if there was a difference in resident versus attending ability to estimate blood loss. We hypothesized that physicians would significantly underestimate blood loss at both cesarean and vaginal delivery, and that there would be no statistical difference in resident versus attending ability. METHODS: A retrospective chart review was performed. A total of 691 deliveries were assessed for both QBL and EBL between April 2014–March 2015. Visual estimation at vaginal delivery was compared to visual estimation at cesarean, using QBL as a comparison standard. Resident ability was compared to attending ability to estimate blood loss. All data were analyzed using chi square test. RESULTS: Underestimation was significantly higher at cesarean, occurring 65% versus 39% of the time at vaginal delivery (P=.002). Contrary to our hypothesis, overestimation was significantly higher at vaginal delivery, occurring 51% versus 33% of the time at cesarean (P=.007). Differences in resident versus attending ability to estimate blood loss did not reach statistical significance. CONCLUSION: Physicians significantly overestimated blood loss at vaginal delivery, and significantly underestimated blood loss at cesarean delivery. There was no difference in resident versus attending ability to estimate blood loss.