Assessment of blood loss during cesarean section under general anesthesia and epidural analgesia using different methods

ABSTRACT

Obstetric blood loss is usually a big issue when dealing with obstetric morbidity and mortality. Blood loss during cesarean section [CS] is usually underestimated; therefore this study addressed that problem by comparing 3 different methods for assessment of blood loss during CS under general anesthesia and epidural analgesia. The study included 100 informed and consented full-term pregnant women undergoing elective CS fulfilling the inclusion criteria. Intraoperatively, for each patient blood loss was assessed by subjectively by visual estimation by the attending staff [obstetrician, anesthetist and the scrub nurse], by weighing of blood-soaked surgical swabs and by calculation using the formula described by Bourke and Smith [15]. The results showed that visual estimation of blood loss gave the lowest estimated value while the calculation gave the highest estimate of blood loss. Anesthetists gave more accurate visual estimation of blood loss than obstetricians, while scrub nurses gave the lowest estimation. Past history of CS, breech presentation, placenta previa and manual separation of the placenta were associated with more blood loss during CS. Neither the type of anesthesia nor the patients' parity had a positive correlation with blood loss while, the weight of the patient had a positive correlation with blood loss. Conclusively, the present study pointed out that calculation of intraoperative blood loss during CS was overestimated by the formula used and was underestimated visually by the obstetricians and scrub nurses involved. Reliably, anesthetists gave a close estimation to that obtained by weighing of swabs method. The study recommended spontaneous removal of the placenta to reduce intraoperative blood loss during elective CS