Implementation of Quantification of Blood Loss Does Not Improve Prediction of Hemoglobin Drop in Deliveries with Average Blood Loss

2017 ◽  
Vol 35 (02) ◽  
pp. 134-139 ◽  
Author(s):  
Rebecca Hamm ◽  
Eileen Wang ◽  
April Romanos ◽  
Kathleen O'Rourke ◽  
Sindhu Srinivas
Keyword(s):  
Blood Loss ◽  
Observational Study ◽  
Postpartum Hemorrhage ◽  
Prospective Observational Study ◽  
Balance Accuracy ◽  
Estimated Blood Loss ◽  
Student’S T ◽  
National Partnership ◽  
Hemoglobin Drop ◽  
Student’S T Test

Objective The National Partnership for Maternal Safety released a postpartum hemorrhage bundle in 2015 recommending quantification of blood loss (QBL) for all deliveries. We sought to determine whether QBL more accurately predicts hemoglobin (Hb) drop than visually estimated blood loss (EBL). Study Design This is a prospective observational study. Preintervention data (PRE) were collected on all deliveries between October 15, 2013 and December 15, 2013. Deliveries were included if EBL, admission Hb, and 12-hour postpartum Hb (12hrCBC) were available. QBL was implemented in July 2015. Postintervention data (POST) were collected between October 20, 2015 and December 20, 2015. A total of 500 mL EBL was predicted to result in 1 g/dL Hb drop at 12hrCBC. Student's t-test was used to compare the means. Results A total of 592 of 626 (95%) PRE and 583 of 613 (95%) POST deliveries were included. Overall, 278 (48%) POST deliveries had QBL recorded. In both PRE and POST, actual Hb drop differed from predicted by 0.6 g/dL in both groups of deliveries. When evaluating deliveries with EBL > 1,000 mL, QBL in POST was slightly better at predicting Hb drop versus EBL in PRE, although not statistically significant (0.2 vs. 0.5 g/dL, p = 0.17). Conclusion In all deliveries, QBL does not predict Hb drop more accurately than EBL. The decision to perform QBL needs to balance accuracy with a resource intense measurement process.

Evaluation of measured postpartum blood loss after vaginal delivery using a collector bag in relation to postpartum hemorrhage management strategies: a prospective observational study

2016 ◽  
Vol 44 (4) ◽  
Author(s):  
Christian Bamberg ◽  
Katja Niepraschk-von Dollen ◽  
Laura Mickley ◽  
Anne Henkelmann ◽  
Larry Hinkson ◽  
...  
Keyword(s):  
Blood Loss ◽  
Observational Study ◽  
Vaginal Delivery ◽  
Postpartum Hemorrhage ◽  
Prospective Observational Study ◽  
Management Strategies ◽  
Population Based ◽  
University Hospital ◽  
Hemoglobin Content ◽  
Vaginal Deliveries

AbstractTo evaluate the incidence of postpartum hemorrhage (PPH) and severe PPH via routine use of a pelvic drape to objectively measure blood loss after vaginal delivery in connection with PPH management.This prospective observational study was undertaken at the obstetrical department of the Charité University Hospital from December 2011 to May 2013 and evaluated an unselected cohort of planned vaginal deliveries (n=1019 live singletons at term). A calibrated collecting drape was used to meassure blood loss in the third stage of labor. PPH and severe PPH were defined as blood loss ≥500 mL and ≥1000 mL, respectively. Maternal hemoglobin content was evaluated at admission to delivery and at the first day after childbirth.During the study period, 809 vaginal deliveries were analysed. Direct measurement revealed a median blood loss of 250 mL. The incidences of PPH and severe PPH were 15% and 3%, respectively. Mean maternal hemoglobin content at admission was 11.9±1.1 g/dL, with a mean decrease of 1.0±1.1 g/dL. Blood loss measured after vaginal delivery correlated significantly with maternal hemoglobin decrease.This study suggests that PPH incidence may be higher than indicated by population-based data. Underbuttocks drapes are simple, objective bedside tools to diagnose PPH. Blood loss should be quantified systematically if PPH is suspected.

scholarly journals Establishing a national high fidelity cadaveric emergency urology simulation course to increase trainee preparedness for independent on-call practice: a prospective observational study

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Nicholas Bullock ◽  
Thomas Ellul ◽  
Suzanne Biers ◽  
James Armitage ◽  
Sophia Cashman ◽  
...  
Keyword(s):  
Observational Study ◽  
Prospective Observational Study ◽  
Course Completion ◽  
Confidence Score ◽  
High Fidelity ◽  
Emergency Procedures ◽  
The United Kingdom ◽  
Wide Range ◽  
Student’S T ◽  
Numeric Scale

Abstract Background Whilst competence in the management of a wide range of urological emergencies is a requirement for certification in urology, many conditions are uncommon and exposure during training may be limited. This prospective observational study sought to evaluate the feasibility and effectiveness of a standardised cadaveric emergency urology simulation course aimed at improving operative confidence and competence prior to independent on-call practice in the United Kingdom. Methods A two-day cadaveric emergency urology simulation course supported by the British Association of Urological Surgeons (BAUS) was implemented at two pilot centres. All delegates that undertook one of the initial series of courses were invited to complete online pre- and post-course questionnaires relating to prior operative experience, documented competence and perceived confidence in being able to perform specific emergency procedures independently. Primary outcome was a self-reported ‘confidence score’ selected from a linear numeric scale ranging from 1 (not at all confident to perform a given procedure independently) to 10 (fully confident). Statistical analysis was undertaken using SPSS Statistics for Mac Version 25 and the paired student’s t-test used to compare mean pre- and post-course scores. Results One hundred and four delegates undertook the course during the study period. Of these, 85 (81.7%) completed the pre-course survey and 67 (64.4%) completed the post-course survey, with 61 (58.7%) completing both. The greatest proportion of respondents were Speciality Trainees in Urology of ST5 level or higher (equivalent of Resident/Fellows with 4 or more years of surgical training; n = 31, 36.5%). Delegates reported variable pre-course exposure, with most experience reported in loin approach to the kidney (median 10) and least in exploration and packing of a transurethral resection cavity and emergency nephrectomy (median 0). Following course completion, a statistically significant increase in confidence score was observed for each procedure, with the greatest increases seen for shunt for priapism (4.87 to 8.80, p < 0.001), ureteric reimplantation (3.52 to 7.33, p < 0.001) and primary ureteric anastomosis (3.90 to 7.49, p < 0.001). Conclusions A standardised high fidelity cadaveric simulation course is feasible and significantly improves the confidence of trainees in performing a wide range of emergency procedures to which exposure is currently limited.

Institution of a Comprehensive Postpartum Hemorrhage Bundle at a Large Academic Center does not Immediately Reduce Maternal Morbidity

2018 ◽  
Vol 36 (01) ◽  
pp. 015-021 ◽  
Author(s):  
Eileen Wang ◽  
Kathleen O'Rourke ◽  
April Romanos ◽  
Sindhu Srinivas ◽  
Rebecca Hamm
Keyword(s):  
Postpartum Hemorrhage ◽  
Maternal Morbidity ◽  
University Of Pennsylvania ◽  
Transfusion Rate ◽  
Long Term Effects ◽  
Academic Center ◽  
Estimated Blood Loss ◽  
The University ◽  
Hemoglobin Drop

Objective Obstetric hemorrhage is a leading cause of morbidity and mortality. We sought to assess whether institution of a postpartum hemorrhage (PPH) bundle could improve maternal morbidity in our population. Study Design Preintervention data (PRE) was collected on all deliveries at Hospital of the University of Pennsylvania between October 15, 2013 and December 15, 2013. A two-pronged, multidisciplinary educational and procedural intervention related to PPH was instituted from March 2015 to June 2015. Postintervention data (POST) was collected on all deliveries from October 20, 2015 to December 20, 2015. Results Note that 592 of 626 (95%) PRE and 583 of 613 (95%) POST deliveries were included. The rates of PPH by estimated blood loss (EBL) ≥ 1,000 mL and by 3 g hemoglobin drop were not significantly different from PRE to POST (9.0% versus 12.2%, p = 0.07 and 10.5% versus 13.5%, p = 0.10, respectively). There was no significant change in transfusion rate (3.4% versus 5.1%, p = 0.13). Use of uterotonics was reduced from 9.8 to 6.3% from PRE to POST (p = 0.03). Conclusion While institution of a PPH bundle is designed to improve the morbidity of PPH, our data demonstrate that it cannot be expected to do so within 6 months of implementation. Further studies will need to assess the long-term effects of such a resource-intensive protocol, including perceptions of improved safety by all providers, nurses, and staff.

scholarly journals Tranexamic acid in prevention of postpartum hemorrhage in elective cesarean section

2019 ◽  
Vol 8 (2) ◽  
pp. 372
Author(s):  
Pravin Shah ◽  
Ajay Agrawal ◽  
Shailaja Chhetri ◽  
Pappu Rijal ◽  
Nisha K. Bhatta
Keyword(s):  
Blood Loss ◽  
Cesarean Section ◽  
Tranexamic Acid ◽  
Postpartum Hemorrhage ◽  
Elective Cesarean Section ◽  
Controlled Study ◽  
Control Group ◽  
Estimated Blood Loss ◽  
Elective Cesarean ◽  
The Mean

Background: Postpartum hemorrhage is a common and occasionally life-threatening complication of labor. Cesarean section is associated with more blood loss in compared to vaginal delivery. Despite, there is a trend for increasing cesarean section rates in both developed and developing countries thereby increasing the risk of morbidity and mortality, especially among anemic women. The objective of this study was to evaluate the effect of preoperative administration of intravenous Tranexamic acid on blood loss during and after elective cesarean section.Methods: This was a prospective, randomized controlled study with 160 eligible pregnant women of 37 or more period of gestation. They were all planned for elective cesarean section and were randomized into two groups either to receive 10ml (1gm) of Tranexamic acid intravenously or 10ml of normal saline. Blood loss was measured during and for 24 hours after operation.Results: The mean estimated blood loss was significantly lower in women treated with Tranexamic acid compared with women in the placebo group (392.13 ml±10.06 vs 498.69 ml±15.87, respectively; p<0.001). The mean difference in pre-operative and post-operative hemoglobin levels was statistically significant in the Tranexamic acid group than in the control group (0.31±0.18 vs 0.79±0.23, respectively; p<0.001).Conclusions: Pre-operative use of Tranexamic acid is associated with reduced blood loss during and after elective cesarean section. In a developing country like ours where postpartum hemorrhage is a major threat to the life of the mothers, it seems to be a promising option.

scholarly journals Comparison of blood loss in endoscopic powered adenoidectomy and conventional curettage

2019 ◽  
Vol 5 (3) ◽  
pp. 577
Author(s):  
Nithya Krishnakumar ◽  
N. K. Bashir ◽  
Girish Raj
Keyword(s):  
Radiofrequency Ablation ◽  
Standard Deviation ◽  
Blood Loss ◽  
Observational Study ◽  
Prospective Observational Study ◽  
Conventional Technique ◽  
Nasal Endoscope ◽  
Medical College ◽  
Lower Blood ◽  
The Difference

<p class="abstract"><strong>Background:</strong> Adenoidectomy is one of the most common surgeries done in children. Over the years many techniques have evolved like powered adenoidectomy, radiofrequency ablation, electro cautery etc. Use of endoscopes has enabled surgeons to perform adenoidectomy under direct vision. The objectives of the study were to compare blood loss of conventional and endoscopic assisted powered adenoidectomy.</p><p class="abstract"><strong>Methods:</strong> In this a prospective observational study of 30 children attending ENT department in MES Medical College was done. In the conventional technique, adenoidectomy was done using St Claire Thomson adenoid curette. In powered adenoidectomy technique, micro debrider was used under guidance of 0<sup>0</sup> nasal endoscope (2.7 mm). Intra operatively blood loss during surgery were looked for and noted in both groups.  </p><p class="abstract"><strong>Results:</strong> In the study of 30 children divided in to 2 groups who are comparable statistically. Average blood loss in patients who underwent CA was 38.53 ml and in patients who underwent EAA was 28.27 ml, with standard deviation of 4.704 and 3.863 respectively. The difference in mean blood loss was 10.26 ml.</p><p class="abstract"><strong>Conclusions:</strong> Endoscopic assisted powered adenoidectomy has lower blood loss as compared to conventional adenoidectomy.</p>

Plasma activity of individual coagulation factors, hemodilution and blood loss after cardiac surgery: A prospective observational study

2010 ◽  
Vol 126 (2) ◽  
pp. e128-e133 ◽  
Author(s):  
Lisa Ternström ◽  
Vladimir Radulovic ◽  
Martin Karlsson ◽  
Fariba Baghaei ◽  
Monica Hyllner ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Blood Loss ◽  
Observational Study ◽  
Prospective Observational Study ◽  
Coagulation Factors ◽  
Plasma Activity

scholarly journals Association between Receipt of Intrapartum Magnesium Sulfate and Postpartum Hemorrhage

2021 ◽  
Vol 11 (01) ◽  
pp. e21-e25
Author(s):  
Emily M.S. Miller ◽  
Allie Sakowicz ◽  
Elise Leger ◽  
Elizabeth Lange ◽  
Lynn M. Yee
Keyword(s):  
Blood Loss ◽  
Magnesium Sulfate ◽  
Postpartum Hemorrhage ◽  
Blood Cells ◽  
Uterine Atony ◽  
Hypertensive Disorders Of Pregnancy ◽  
Packed Red Blood Cells ◽  
Hypertensive Disorders ◽  
Estimated Blood Loss ◽  
Secondary Outcomes

Abstract Objective The aim of the study is to investigate the association between intrapartum administration of magnesium sulfate in women with hypertensive disorders of pregnancy and postpartum hemorrhage. Study Design This was a retrospective cohort study of women diagnosed with a hypertensive disorder of pregnancy who delivered singleton gestations >32 weeks at a single, large volume tertiary care center between January 2006 and February 2015. Women who received intrapartum magnesium sulfate for seizure prophylaxis were compared with women who did not receive intrapartum magnesium sulfate. The primary outcome was frequency of postpartum hemorrhage. Secondary outcomes included estimated blood loss, uterine atony, and transfusion of packed red blood cells. Bivariable analyses were used to compare the frequencies of each outcome. Multivariable logistic regression models examined the independent associations of magnesium sulfate with outcomes. Results Of 2,970 women who met inclusion criteria, 1,072 (36%) received intrapartum magnesium sulfate. Women who received magnesium sulfate were more likely to be nulliparous, publicly insured, of minority race or ethnicity, earlier gestational age at delivery, and undergo labor induction. The frequency of postpartum hemorrhage was significantly higher among women who received magnesium sulfate compared with those who did not (12.4 vs. 9.3%, p = 0.008), which persisted after controlling for potential confounders. Of secondary outcomes, there was no difference in estimated blood loss between women who did and did not receive magnesium sulfate (250 mL [interquartile range 250–750] vs. 250 mL [interquartile range 250–750], p = 0.446). However, compared with women who did not receive magnesium sulfate, women who received magnesium sulfate had a greater frequency of uterine atony (8.9 vs 4.9%, p < 0.001) and transfusion of packed red blood cells (2.0 vs. 0.8%, p = 0.008). These differences persisted after controlling for potential confounders. Conclusion Intrapartum magnesium sulfate administration to women with hypertensive disorders of pregnancy is associated with increased odds of postpartum hemorrhage, uterine atony, and red blood cell transfusion.

The validity of Visual Blood Loss Estimation in Postpartum Hemorrhage in Shanghai Hospitals: A Web-based Survey (Preprint)

2019 ◽  
Author(s):  
Ying Liu ◽  
Weiwei Cheng ◽  
Ying Shen ◽  
Lin Rao ◽  
Wei Zhu ◽  
...  
Keyword(s):  
Blood Loss ◽  
Postpartum Hemorrhage ◽  
Descriptive Analysis ◽  
Mainland China ◽  
Visual Estimation ◽  
Chi Square ◽  
Cross Sectional ◽  
Estimated Blood Loss ◽  
Tertiary Hospitals ◽  
Chi Square Test

BACKGROUND Postpartum Hemorrhage has been recognized as the most fatal factor in maternal death. Yet midwives can barely distinguish whether the blood loss has reached a life-threatening amount without precise measurement, particularly during a slow hemorrhage. Also, understaffed midwives in mainland China adds to the difficulty of timely accurate measurement of blood loss. OBJECTIVE To evaluate the accuracy of visual estimated blood loss in postpartum hemorrhage by clinical midwives, as well as the reproducibility of the visual estimation and influencing factors on accuracy. METHODS With a modified on-line visual estimation questionnaire of blood loss, a cross-sectional multicenter study was conducted among voluntary midwives or obstetrical nurses engaged in clinical practice in secondary and tertiary hospitals in Shanghai. A descriptive analysis was performed with demographic features and the rate of accurate responses. The Kappa coefficient was employed to determine the reproducibility of the agreement of visual estimation. The correlations between demographics and items of the questionnaire were conducted with Chi-square test and Spearman correlation analysis. RESULTS A total of 281 midwives and nurses participated in the survey. The finding showed relatively low accuracy and reproducibility of visual estimation, with 25.6% and 17.8% subjects in Shanghai hospitals distinguishing the postpartum hemorrhage (500ml) and the severe postpartum hemorrhage (1000ml), respectively. The Kappa coefficients were slight to moderate (0.062~0.450). The institutional routine for blood loss calculation turned out to be relevant to the accuracy of visual estimation. CONCLUSIONS Visual estimation cannot provide sound validity for blood loss evaluation in postpartum hemorrhage in China, especially when the amount exceeds 500ml. Institutions should make routines on how blood loss can be reckoned with the sterile drapes and gauzes they use, and provide regular training for midwives and nurses.

Adverse Maternal Outcomes Associated with Uterine Extensions at the Time of Cesarean Delivery

2019 ◽  
Vol 36 (08) ◽  
pp. 785-789
Author(s):  
Soha S. Patel ◽  
Nathanael C. Koelper ◽  
Sindhu K. Srinivas ◽  
Mary D. Sammel ◽  
Lisa D. Levine
Keyword(s):  
Maternal Morbidity ◽  
Length Of Hospital Stay ◽  
Maternal Outcomes ◽  
Chi Square ◽  
Exact Test ◽  
Prolonged Length ◽  
Estimated Blood Loss ◽  
Increased Risk ◽  
Student’S T ◽  
Student’S T Test

Objective We sought to compare adverse maternal outcomes between women with and without a uterine extension at the time of cesarean. Study Design We conducted a retrospective cohort study of women with and without a uterine extension during a primary low transverse cesarean of a full-term singleton gestation. The primary outcomes were (1) estimated blood loss (EBL) and (2) composite maternal morbidity (defined as ≥ 1 of the following: blood transfusion, endometritis, or readmission). Pearson's chi-square or Fisher's exact test was used to compare categorical data; Student's t-test or Mann–Whitney's U-tests was used for continuous data. Linear and logistic regressions were used to adjust for confounding factors. Results There were 252 women included (126 with extension and 126 without an extension). Women with extensions had a higher EBL (1,038 vs. 832 mL, p < 0.001) and higher rate of the composite maternal morbidity (19.1 vs. 5.6%, p = 0.001). Additionally, women with extensions had an increased risk of postpartum hemorrhage ≥ 1 L (53.2 vs. 23.8%, p < 0.001) and 1.5 L (12.7 vs. 0%, p < 0.001) and were associated with prolonged length of hospital stay (29 vs. 17%, p = 0.04). Conclusion Uterine extensions are associated with adverse maternal outcomes including higher EBL and increase in maternal morbidity.

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