Biblioteca Virtual en Salud

Post-partum hemorrhage [PPH] is one the major causes of maternal mortality globally. Prediction and diagnosis of severe PPH remains challenging and most deaths due to severe PPH involve delayed in the diagnosis and management of hemorrhage. This delay may result from an underestimation of blood loss at delivery. Many studies indicate that assessment of post-partum blood loss following a vaginal delivery is difficult and visual estimation of blood loss is frequently inaccurate and it underestimates the amount of blood loss in around 45% of cases. A collector transparent plastic bag after delivery is a quantitative and objective method of measuring blood loss. The aim of this study was to assess sensitivity, specificity, positive predictive value [PPV], negative predictive value [NPV] of a collector bag. The correlation between bag's volume and hemoglobin [Hb] and hematocrit [Ht] variation was also examined. This study was carried out with 100 women referred for admission to labor ward in 2007. After measuring serum Hb and Ht in admission, a collecting bag in size 84x28 cm and thickness of 70 micron was to be placed under the pelvis of the mother as soon as the baby was born and was weighed after delivery. Hb and Ht were assessed before and 8 hr after delivery. Each 500 ml blood loss accounts for approximately a 3% change in the Ht level or a falling in Hb of 1 g/dl. Statistical analyses were performed using Chi square and T tests. Sensitivity, specificity, PPV and NPV indices of collecting bag were compared to laboratory tests [Hb, Ht]. Post-partum hemorrhage was defined by a blood loss > 500 ml or a fall of Ht> 3%, or by a fall of Hb>1g/dL. Collector bag had Sensitivity =88.9%, Specificity=91.8%, PPV =80% and NPV= 95.7% to detect the PPH. For Hb=1 the calculated bag volume was 500 ml. With this cut off, we noted Sensitivity=80%, Specificity=95.7%, PPV= 88.9% and NPV= 91.8%.The collector pelvic bag is a rapid and precise instrument to diagnose post partum hemorrhage in delivery room. It also enables a visual, quantitative and objective estimation of blood loss.