Postpartum blood loss: visual estimation versus objective quantification with a novel birthing drape

<p><b>INTRODUCTION</b>Immediate postpartum haemorrhage (PPH) is the most common cause of maternal mortality worldwide. Most recommendations focus on its prevention and management. Visual estimation of blood loss is widely used for the early detection of PPH, but the most appropriate method remains unclear. This study aimed to compare the efficacy of visual estimation and objective measurement using a sterile under-buttock drape, to determine the volume of postpartum blood loss.</p><p><b>METHODS</b>This study evaluated patients aged ≥ 18 years with low-risk term pregnancies, who delivered vaginally. Immediately after delivery, a birth attendant inserted the drape under the patient's buttocks. Postpartum blood loss was measured by visual estimation and then compared with objective measurement using the drape. All participants received standard intra- and postpartum care.</p><p><b>RESULTS</b>In total, 286 patients with term pregnancies were enrolled. There was a significant difference in postpartum blood loss between visual estimation and objective measurement using the under-buttock drape (178.6 ± 133.1 mL vs. 259.0 ± 174.9 mL; p < 0.0001). Regarding accuracy at 100 mL discrete categories of postpartum blood loss, visual estimation was found to be inaccurate, resulting in underestimation, with low correspondence (27.6%) and poor agreement (Cohen's kappa coefficient 0.07; p < 0.05), compared with objective measurement using the drape. Two-thirds of cases of immediate PPH (65.4%) were misdiagnosed using visual estimation.</p><p><b>CONCLUSION</b>Visual estimation is not optimal for measurement of postpartum blood loss in PPH. This method should be withdrawn from standard obstetric practice and replaced with objective measurement using the sterile under-buttock drape.</p>

Accuracy of Blood Loss Determination after Vaginal Delivery: Visual Estimation versus Calibrated Measurement.

Background: The ability to determine accurately, the blood loss during childbirth is of extreme importance in the diagnosis and management of primary postpartum haemorrhage (PPH). Aims: In this study, we evaluate the effectiveness of visual estimation of blood loss, as a method of diagnosing primary postpartum haemorrhage. Methodology: A cross-sectional study on 271 participants was conducted between April and October 2012, at the Komfo Anokye Teaching Hospital. Women who went through spontaneous vaginal delivery were monitored and blood loss after delivery was visually estimated and then measured with a graduated receptacle, up to 1 hour post-delivery. The paired t-test and Bland- Altman plot was used to compare outcomes of the two methods. P<0.05 was considered significant. Results: Mean age of study participants was 27.7±5.7. As per visual estimation, most participants were reported to have lost <200 ml of blood (45.0%) as opposed to that of measured losses where most participants had lost between 200-500 ml of blood (48.7%). The mean measured blood loss was 306.09±218.39 ml against a 250±188.78 ml mean visually estimated blood loss (P < 0.0001). Prevalence of primary PPH as estimated with measured blood losses was 20.3% (55/271). Visual estimation, however gave a prevalence of 15.9% (43/271), an underestimation by 4.4%. A Bland- Altman plot showed a clinical bias large enough to cause significant differences in diagnosis of primary PPH. Conclusion: This study adds to existing evidence that the visual estimation of blood loss in clinical settings underestimates losses and is not reliable. This can lead to misdiagnosis of primary PPH and thus an underestimation of the condition. Health care workers should therefore base diagnosis on calibrated measurement methods.

Comparación de dos métodos diagnósticos de ictericia neonatal / Comparison of two diagnostic methods of neonatal jaundice

Introducción: la ictericia neonatal es uno de los síndromes más frecuentes de la neonatología. El tratamiento al recién nacido ictérico ha tenido históricamente diferentes guías para sus decisiones. Objetivo: establecer una comparación entre los métodos diagnósticos de la escala visual y la dosificación en sangre de la bilirrubina total en los recién nacidos. Métodos: se realizó una investigación observacional, descriptiva, transversal, en el Hospital Ginecoobstétrico Docente de Guanabacoa de enero a julio de 2008. La muestra estuvo constituida por 86 recién nacidos. Resultados: el mayor número de recién nacidos fueron a término y normopesos. Existió predominio de la zona IV de la escala visual de Kramer. El mayor número de casos tuvo valores de bilirrubina sérica entre 10-12 mg/dL. Conclusiones: existió relación entre ambos métodos de evaluación de la ictericia neonatal.

Introduction: the neonatal jaundice is one of the more frequent syndromes of the neonatology. Treatment to icteric newborn has had historically different guidelines for its decisions. Objective: to establish a comparison among the diagnostic methods of the visual scale and the dosing in blood of the total bilirubin in newborns. Methods: a cross-sectional, descriptive and observational research was conducted in the Gynecology Obstetrics Teaching Hospital of Guanabacoa municipality from January to July, 2008. Sample included 86 newborns. Results: the great number of newborns was the term ones and those with a normal weight. There was predominance of the IV zone of the Kramer's visual scale. The great figure of cases had values of serum bilirubin between 10-12 mg/dL. Conclusions: there was a relation between both methods of assessment of the neonatal jaundice.

Evaluation of depth of myometrial invasion by gross visual estimation versus microscopic technique.

A diagnostic test evaluation was performed to compare the evaluation of depth of myometrial invasion by gross visual estimation versus microscopic examination in the uteri of 40 patients who had endometrial adenocarcinoma and underwent surgical treatment in Siriraj Hospital from November 1993 to March 1995. The accuracy of gross visual estimation was 85%, the sensitivity was 63.6% (95% CI=31.6-87.6), the specificity was 93.1% (95%CI=75.8-98.8), the positive predictive value was 77.8% (95% CI=40.2-96.1), the negative predictive value was 87.1% (95% CI=69.2-95.8), the false positive rate was 6.9% and the false negative rate was 36.4%. Although gross visual estimation showed good specificity, high false negative rate and should not be used in preference to microscopic examination.