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

INTRODUCTION: 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. METHODS: 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. RESULTS: 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. CONCLUSION: 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 This method should be withdrawn from standard obstetric practice and replaced with objective measurement using the sterile under-buttock drape.

Lingual frenulum and effect on breastfeeding in Thai newborn infants.

BACKGROUND: Breastfeeding has abundant biological and psychological benefits. Effective breastfeeding requires good latching on, which is possible when the infant is able to cup around the maternal areola with his tongue. One of the most common conditions resulting in poor latching on is tongue-tie. OBJECTIVE: To determine the prevalence of tongue-tie with subsequent breastfeeding difficulties and other factors affecting the success of breastfeeding in newborn infants. METHODS: This was a prospective, cross-sectional study of healthy Thai infants without contraindications for breastfeeding. Physical examination of the infants and mothers and their breastfeeding practices were assessed between 24 and 48 hours of life. RESULTS: 2679 mother-infant dyads were recruited. The study detected a prevalence of 16% for severe tongue-tie, 37.9% of which was associated with breastfeeding difficulties. Using multiple logistic regression analysis, moderate (adjusted OR 13.3, 95% CI 7.2-24.5) and severe (adjusted OR 62, 95% CI 34.1-112.8) tongue-tie, short nipples (adjusted OR 1.5, 95% CI 1.1-2.2), mothers feeling the infant's tongue on the nipple area (adjusted OR 3.4, 95% CI 2.2-5.2) and mothers' inability to feel the infant's tongue (adjusted OR 11.8, 95% CI 4.3-32.4) independently increased the risk of breastfeeding difficulties. CONCLUSIONS: Tongue-tie is not uncommon and is associated with breastfeeding difficulty in newborn infants. Mothers of infants with severe tongue-tie should be closely and individually coached during breastfeeding and followed up, especially during the first critical weeks of the infant's life.