G Lilley1, D Burkett-St-Laurent2, E Precious3, D Bruynseels2, A Kaye4, J Sanders5, R Alikhan3, P W Collins6, J E Hall7, R E Collis2. 1. Department of Anaesthetics and Pain Control, Cardiff and Vale University Health Board, UK. Electronic address: lilleygj@hotmail.com. 2. Department of Anaesthetics and Pain Control, Cardiff and Vale University Health Board, UK. 3. Department of Haematology, Cardiff and Vale University Health Board, UK. 4. Department of Obstetrics, Cardiff and Vale University Health Board, UK. 5. Department of Obstetrics, Cardiff and Vale University Health Board, UK; Institute of Translation, Innovation, Methodology and Engagement, South East Wales Trials Unit, Cardiff University School of Medicine, UK. 6. Department of Haematology, Cardiff and Vale University Health Board, UK; Institute of Infection and Immunity, Critical Illness Research Group, Cardiff University School of Medicine, UK. 7. Department of Anaesthetics and Pain Control, Cardiff and Vale University Health Board, UK; Institute of Infection and Immunity, Critical Illness Research Group, Cardiff University School of Medicine, UK.
Abstract
BACKGROUND: We set out to validate the accuracy of gravimetric quantification of blood loss during simulated major postpartum haemorrhage and to evaluate the technique in a consecutive cohort of women experiencing major postpartum haemorrhage. The study took part in a large UK delivery suite over a one-year period. All women who experienced major postpartum haemorrhage were eligible for inclusion. METHODS: For the validation exercise, in a simulated postpartum haemorrhage scenario using known volumes of artificial blood, the accuracy of gravimetric measurement was compared with visual estimation made by delivery suite staff. In the clinical observation study, the blood volume lost during postpartum haemorrhage was measured gravimetrically according to our routine institutional protocol and was correlated with fall in haemoglobin. The main outcome measure was the accuracy of gravimetric measurement of blood loss. RESULTS: Validation exercise: the mean percentage error of gravimetrically measured blood volume was 4.0±2.7% compared to visually estimated blood volume with a mean percentage error of 34.7±32.1%. Clinical observation study: 356 out of 6187 deliveries were identified as having major postpartum haemorrhage. The correlation coefficient between measured blood loss and corrected fall in haemoglobin for all patients was 0.77; correlation was stronger (0.80) for postpartum haemorrhage >1500mL, and similar during routine and out-of-hours working. CONCLUSION: The accuracy of the gravimetric method was confirmed in simulated postpartum haemorrhage. The clinical study shows that gravimetric measurement of blood loss is correlated with the fall in haemoglobin in postpartum haemorrhage where blood loss exceeds 1500mL. The method is simple to perform, requires only basic equipment, and can be taught and used by all maternity services during major postpartum haemorrhage.
BACKGROUND: We set out to validate the accuracy of gravimetric quantification of blood loss during simulated major postpartum haemorrhage and to evaluate the technique in a consecutive cohort of women experiencing major postpartum haemorrhage. The study took part in a large UK delivery suite over a one-year period. All women who experienced major postpartum haemorrhage were eligible for inclusion. METHODS: For the validation exercise, in a simulated postpartum haemorrhage scenario using known volumes of artificial blood, the accuracy of gravimetric measurement was compared with visual estimation made by delivery suite staff. In the clinical observation study, the blood volume lost during postpartum haemorrhage was measured gravimetrically according to our routine institutional protocol and was correlated with fall in haemoglobin. The main outcome measure was the accuracy of gravimetric measurement of blood loss. RESULTS: Validation exercise: the mean percentage error of gravimetrically measured blood volume was 4.0±2.7% compared to visually estimated blood volume with a mean percentage error of 34.7±32.1%. Clinical observation study: 356 out of 6187 deliveries were identified as having major postpartum haemorrhage. The correlation coefficient between measured blood loss and corrected fall in haemoglobin for all patients was 0.77; correlation was stronger (0.80) for postpartum haemorrhage >1500mL, and similar during routine and out-of-hours working. CONCLUSION: The accuracy of the gravimetric method was confirmed in simulated postpartum haemorrhage. The clinical study shows that gravimetric measurement of blood loss is correlated with the fall in haemoglobin in postpartum haemorrhage where blood loss exceeds 1500mL. The method is simple to perform, requires only basic equipment, and can be taught and used by all maternity services during major postpartum haemorrhage.
Authors: Nathan T Connell; Paula D James; Romina Brignardello-Petersen; Rezan Abdul-Kadir; Barbara Ameer; Alice Arapshian; Susie Couper; Jorge Di Paola; Jeroen Eikenboom; Nicolas Giraud; Jean M Grow; Sandra Haberichter; Vicki Jacobs-Pratt; Barbara A Konkle; Peter Kouides; Michael Laffan; Michelle Lavin; Frank W G Leebeek; Claire McLintock; Simon McRae; Robert Montgomery; Sarah H O'Brien; James S O'Donnell; Margareth C Ozelo; Nikole Scappe; Robert Sidonio; Alberto Tosetto; Angela C Weyand; Mohamad A Kalot; Nedaa Husainat; Reem A Mustafa; Veronica H Flood Journal: Blood Adv Date: 2021-01-26
Authors: K Seligman; B Ramachandran; P Hegde; E T Riley; Y Y El-Sayed; L M Nelson; A J Butwick Journal: Int J Obstet Anesth Date: 2017-03-22 Impact factor: 2.603
Authors: Sarah F Bell; Rachel E Collis; Philip Pallmann; Christopher Bailey; Kathryn James; Miriam John; Kevin Kelly; Thomas Kitchen; Cerys Scarr; Adam Watkins; Tracey Edey; Elinore Macgillivray; Kathryn Greaves; Ingrid Volikas; James Tozer; Niladri Sengupta; Iolo Roberts; Claire Francis; Peter W Collins Journal: BMC Pregnancy Childbirth Date: 2021-05-15 Impact factor: 3.007
Authors: Sarah Frances Bell; Thomas Kitchen; Miriam John; Cerys Scarr; Kevin Kelly; Christopher Bailey; Kathryn James; Adam Watkins; Elinore Macgillivray; Tracey Edey; Kathryn Greaves; Ingrid Volikas; James Tozer; Niladril Sengupta; Claire Francis; Rachel Collis; Peter Collins Journal: BMJ Open Qual Date: 2020-04