Decisions/Results- “Measured blood loss by the

weighted blood loss (WBL) had

poor sensitivity for detection of

PPH compared to a reference

standard of a hemoglobin drop

>10%.”[2]

- “Underestimation was more

prominent in cases where more

than average-excessive blood

losses were simulated while

over estimations or accurate

estimations were more

prominent in less than average

blood loss incidents when using

WBL methods.”[1]

- Though quantitative changes in

hemoglobin pose more

accurate results, it is not an

optimal method of choice due to

its high cost.[2]

- WBL yields more accurate

results when done quickly to

reduce evaporation loss.[7]

- “The correlation coefficient

between measured blood loss

and corrected fall in hemoglobin

for all patients was 0.77;

correlation was stronger (0.80)

for postpartum hemorrhage

>1500mL.”[5]

Interventions- Ensure the stability of the patient

and make sure the uterus is firm,

bladder is empty, and no cervical

lacerations exist.[3]

- B-lynch suture can be used to

squeeze the uterus in order to stop

excessive bleeding. [3]

- Simple education programs for

assessing WBL can improve the

incidence of under-estimation when

assessing for PPH.[1]

- Evaluation of the cause of the PPH,

initiating oxytocin, draining the

bladder, fundal massage, and

administration of methylergonovine maleate. [3]

Quantifying Blood Loss in a

Postpartum HemorrhageJada LaFosse & April Troop

Faculty Mentor: Dr. Leslie Collins

Definitions- Postpartum hemorrhage (PPH):

historically defined as blood loss

>500cc for vaginal delivery and

>1,000cc for C-section delivery.

- Placenta previa: placenta is

attached to the uterine wall close to

or covering the cervix.

- Placental abruption: detachment of

the placenta before delivery.

- Accreta: placenta remains firmly

attached after delivery due to the

deep implantation of blood vessels

and placental tissues into the

uterus.

- Chorioamnionitis: inflammation of

fetal membranes due to infection.

PICOT QuestionIn a postpartum patient, does determining blood

loss via quantitative changes in hemoglobin

versus weighing postpartum pads yield more

accurate assessment information/diagnosis in a

postpartum hemorrhage?

Risk Factors- Placenta previa, abruption, and

accreta

- Multiple pregnancy (e.g., twins)

- Large for gestational age newborn

(more than 8.8 lbs)

- Failure to progress during the 2nd

stage of labor

- Instrumented delivery

- Maternal hypertensive disorder

(preeclampsia)

- Prior history of PPH

- Chorioamnionitis

- Prior C-section or uterine surgery

References

[1] Al-Kadri, H. M., Dahlawi, H., Airan, M. A., Elsherif, E., Tawfeeq, N., Mokhele, Y., . . . Tamim,

H. M. (2014). Effect of education and clinical assessment on the accuracy of postpartum

blood loss estimation. BMC Pregnancy and Childbirth, 14, 110. doi:10.1186/1471-2393-

14-110 (Hierarchy level 9)

[2] Atukunda, E. C., Mugyenyi, G. R., Obua, C., Atuhumuza, E. B., Musinguzi, N., Tornes, Y. F.,

. . . Siedner, M. J. (2016). Measuring Post-Partum Haemorrhage in Low-Resource

Settings: The Diagnostic Validity of Weighed Blood Loss versus Quantitative Changes in

Hemoglobin. Plos One, 11(4). doi:10.1371/journal.pone.0152408 (Hierarchy level 11)

[3] D'Alton, M. E., Cohen, J. S., Weinstein, D. L., & Dweck, M. F. (2014). Understanding Best

Practices in the Management and Treatment of Postpartum Hemorrhage. Contemporary

OB/GYN, 1-8. Retrieved October 25, 2017. (Hierarchy level 1)

[4] Humphrey, J. (15). Primary Cesarean Delivery Results in Emergency Hysterectomy due to

Placenta Accreta: A Case Study. AANA Journal , 83(1), 28-34. Retrieved October 26,

2017. (Hierarchy level 1)

[5] Lilley, G., Burkett-St-Laurent, D., Precious, E., Bruynseels, D., Kaye, A., Sanders, J., . . .

Collis, R. (2015). Measurement of blood loss during postpartum haemorrhage

[Abstract]. International Journal of Obstetric Anesthesia, 24(1), 8-14.

doi:10.1016/j.ijoa.2014.07.009 (Hierarchy level 7 )

[6] Rajput, V. (2013). Placenta Previa and its Management . Asian Journal of Nursing

Education & Research, 3(3), 134-135. Retrieved October 25, 2017. (Hierarchy level 1)

[7] Schorn, M. (2010). Measurement of Blood Loss: Review of the Literature. Journal of

Midwifery & Women's Health, 55(1), 20-27. Retrieved October 25, 2017, from

https://www.medscape.com/viewarticle/716622. (Hierarchy level 9)

(n.d.). Retrieved October 25, 2017, fromhttps://www.nature.com/articles/srep46333/figures/2