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Am J Perinatol 2019; 36(13): 1332-1336
DOI: 10.1055/s-0039-1688823
SMFM Fellowship Series Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Effect of Implementing Quantitative Blood Loss Assessment at the Time of Delivery

Elizabeth Coviello 
1   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, MedStar Washington Hospital Center, Washington, District of Columbia
2   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, MedStar Georgetown University Hospital, Washington, District of Columbia
,
Sara Iqbal
1   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, MedStar Washington Hospital Center, Washington, District of Columbia
,
Tetsuya Kawakita 
1   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, MedStar Washington Hospital Center, Washington, District of Columbia
2   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, MedStar Georgetown University Hospital, Washington, District of Columbia
,
Rebecca Chornock
3   Department of Obstetrics and Gynecology, MedStar Washington Hospital Center, Washington, District of Columbia
,
Megan Cheney
3   Department of Obstetrics and Gynecology, MedStar Washington Hospital Center, Washington, District of Columbia
,
Sameer Desale
4   Department of Biostatistics and Biomedical Informatics, MedStar Health Research Institute, Hyattsville, Maryland
,
Melissa Fries
1   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, MedStar Washington Hospital Center, Washington, District of Columbia
› Author Affiliations
Funding This project was funded by the Department of Obstetrics and Gynecology at MedStar Washington Hospital Center.
Further Information

Publication History

13 November 2018

02 April 2019

Publication Date:
14 May 2019 (online)

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Abstract

Objective To evaluate the ability of estimated blood loss (EBL) and quantitative blood loss (qBL) to predict need for blood transfusion in women with postpartum hemorrhage (PPH).

Study Design This is a retrospective chart review that identified women with PPH (>1,000 mL for vaginal or cesarean delivery) between September 2014 and August 2015, reported by EBL (n = 92), and October 2015 and September 2016, reported by qBL (n = 374). The primary metric was the area under the receiver-operating characteristic curve for blood transfusion.

Results The rate of PPH by EBL and qBL was 2.8 and 10.8%, respectively (p < 0.01). The rate of transfusion for women meeting criteria for PPH by EBL and QBL were 2% (66/3,307) and 2.7% (93/3,453), respectively (p = 0.06). Postpartum transfusion was predicted by an EBL of 1,450 mL with AUC 0.826 and qBL 1,519 mL with AUC 0.764, for all modes of delivery. Postpartum vital signs and change in pre- and postdelivery hematocrit were poor predictors for transfusion.

Conclusion The rates of PPH increased with the implementation of qBL. Overall, qBL did not perform better than EBL in predicting the need for blood transfusion.

Keywords

postpartum hemorrhage - blood transfusion - quantitative blood loss - estimated blood loss

Note

This study was presented in poster format at the 38th Annual Pregnancy Meeting, Society for Maternal-Fetal Medicine, Dallas, TX, January 29–February 2, 2018.