Quantitative Measurement of Blood Loss During Delivery

Abstract

Objective To facilitate a change in behavior from visual estimation of blood loss to objective quantification of blood loss during delivery. Secondly, to examine the effect of quantification of blood loss on identification of hemorrhage during birth. Design Prospective cohort to examine two methods to measure blood loss, visual and gravimetric, used by physicians and nurses. Sample A convenience sample of 52 birth cases was evaluated. Methods After approval from the Institutional Review Board, a prospective cohort, evidence‐based project at a suburban hospital in the southern United States was implemented from January 1, 2014 to March 30, 2014. All women who were scheduled for delivery, older than age 18, and spoke English were included in the project. After patient consent, the physician was notified of inclusion. Postpartum blood loss was visually estimated by the physicians and nurses. The research team quantified the blood loss by gravimetrically weighing blood lost, subtracting the dry weight, and adding the fluid in drapes and containers. The amniotic fluid was collected separately and not included. The visual and quantified estimates were compared. Implementation Strategies Donabedian's quality model provided a structured, organized way to improve the process of estimating blood loss for the obstetric patient. Additionally, Lewin's change model was used to change practice. Change occurred during implementation as physicians and nurses learned quantification methods and gained satisfaction in knowing that measurements were objective. The final stage or freezing happened when the data were presented and policy was changed. Ongoing data regarding response to maternal hemorrhage are based on objective quantification of blood loss. Results Physicians and registered nurses underestimated (p = .0001) the amount of blood loss at delivery by 21% to 28%. Registered nurses were inconsistent in underestimating blood loss (p = .441). There were no linear correlations or significance differences between hematocrit and hemoglobin postdelivery. Through a paired t test, a significant difference (p = .0001) between visual and gravimetric estimation of blood loss was found. Conclusion/Implications for Nursing Practice Accurate assessment and recognition of postpartum hemorrhage is an essential skill. Researchers indicate that quantitative measurement of blood loss is an accurate method and visual assessment should be eliminated from practice. Knowing the accurate, objective amount of blood lost will enable the health care team to recognize and respond faster to an obstetric hemorrhage. To facilitate a change in behavior from visual estimation of blood loss to objective quantification of blood loss during delivery. Secondly, to examine the effect of quantification of blood loss on identification of hemorrhage during birth. Prospective cohort to examine two methods to measure blood loss, visual and gravimetric, used by physicians and nurses. A convenience sample of 52 birth cases was evaluated. After approval from the Institutional Review Board, a prospective cohort, evidence‐based project at a suburban hospital in the southern United States was implemented from January 1, 2014 to March 30, 2014. All women who were scheduled for delivery, older than age 18, and spoke English were included in the project. After patient consent, the physician was notified of inclusion. Postpartum blood loss was visually estimated by the physicians and nurses. The research team quantified the blood loss by gravimetrically weighing blood lost, subtracting the dry weight, and adding the fluid in drapes and containers. The amniotic fluid was collected separately and not included. The visual and quantified estimates were compared. Donabedian's quality model provided a structured, organized way to improve the process of estimating blood loss for the obstetric patient. Additionally, Lewin's change model was used to change practice. Change occurred during implementation as physicians and nurses learned quantification methods and gained satisfaction in knowing that measurements were objective. The final stage or freezing happened when the data were presented and policy was changed. Ongoing data regarding response to maternal hemorrhage are based on objective quantification of blood loss. Physicians and registered nurses underestimated (p = .0001) the amount of blood loss at delivery by 21% to 28%. Registered nurses were inconsistent in underestimating blood loss (p = .441). There were no linear correlations or significance differences between hematocrit and hemoglobin postdelivery. Through a paired t test, a significant difference (p = .0001) between visual and gravimetric estimation of blood loss was found. Accurate assessment and recognition of postpartum hemorrhage is an essential skill. Researchers indicate that quantitative measurement of blood loss is an accurate method and visual assessment should be eliminated from practice. Knowing the accurate, objective amount of blood lost will enable the health care team to recognize and respond faster to an obstetric hemorrhage.