Accuracy of Blood Loss Measurement during Cesarean Delivery

• Published in: American journal of perinatology reports 2017-04, Vol.7 (2), p.e93-e100
• Main Authors: Doctorvaladan, Sahar V., Jelks, Andrea T., Hsieh, Eric W., Thurer, Robert L., Zakowski, Mark I., Lagrew, David C.
• Format: Article
• Language: English
• Subjects: blood loss measurement; Case Report; cesarean delivery; postpartum hemorrhage; quality improvement
• ISSN: 2157-6998; 2157-7005
• DOI: 10.1055/s-0037-1601382

Abstract Objective  This study aims to compare the accuracy of visual, quantitative gravimetric, and colorimetric methods used to determine blood loss during cesarean delivery procedures employing a hemoglobin extraction assay as the reference standard. Study Design  In 50 patients having cesarean deliveries blood loss determined by assays of hemoglobin content on surgical sponges and in suction canisters was compared with obstetricians' visual estimates, a quantitative gravimetric method, and the blood loss determined by a novel colorimetric system. Agreement between the reference assay and other measures was evaluated by the Bland–Altman method. Results  Compared with the blood loss measured by the reference assay (470 ± 296 mL), the colorimetric system (572 ± 334 mL) was more accurate than either visual estimation (928 ± 261 mL) or gravimetric measurement (822 ± 489 mL). The correlation between the assay method and the colorimetric system was more predictive (standardized coefficient = 0.951, adjusted R 2  = 0.902) than either visual estimation (standardized coefficient = 0.700, adjusted R 2  = 00.479) or the gravimetric determination (standardized coefficient = 0.564, adjusted R 2  = 0.304). Conclusion  During cesarean delivery, measuring blood loss using colorimetric image analysis is superior to visual estimation and a gravimetric method. Implementation of colorimetric analysis may enhance the ability of management protocols to improve clinical outcomes.