Can measuring blood loss at delivery reduce hemorrhage-related morbidity?

Katz, Daniel; Farber, Michaela K.

doi:10.1016/j.ijoa.2021.102968

Cited by 10 publications

(3 citation statements)

References 72 publications

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“…In our study, we directly measured blood loss with QBL. 17 To our knowledge, only one other study has used QBL and the authors just found an association between antenatal mean platelet volume and platelet distribution width values (i.e., not platelet count) and blood loss. 6 Further, that study only enrolled 42 patients, which limits any conclusions.…”

Section: Discussionmentioning

confidence: 93%

Is There an Association between Platelet Count and Blood Loss in the Parturient? A Retrospective Study

Beilin,

Liu,

Hyers

et al. 2023

Am J Perinatol

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Objective The influence of thrombocytopenia on blood loss and postpartum hemorrhage (PPH) has been conflicting. Our aim was to determine if there is an association between predelivery platelet count and quantitative blood loss (QBL) and PPH in both vaginal (VD) and cesarean deliveries (CD). Study Design We conducted a retrospective database study at a single institution from April 1, 2017 to September 9, 2020. The platelet count closest to time of delivery and the QBL was assessed separately for VD and CD. Results A total of 22,479 records were reviewed, of which 16,822 (75%) were VD and 5,657 (25%) were CD. A total of 2,600 (12%) patients had thrombocytopenia, defined as a platelet count <150,000/mm3. Of these, 1,980 (76%) had a VD and 620 (24%) had CD. We found a statistically significant difference in QBL between parturients with thrombocytopenia compared with those without, with a median estimated difference in QBL of 25 (95% confidence interval [CI]: 16–32) and 57 mL (95% CI: 31–87) in VD and CD patients, respectively. We also found a statistically significant difference in QBL when comparing patients among all the platelet count ranges except in the lowest platelet count range of 50,000 to 69,999/mm3 with a mean difference of 52 (95% CI: 25–81) and 107 mL (95% CI: 39–180) in the VD and CD patients, respectively in the platelet count range of 70,000 to 99,999/mm3 . We also found the incidence of PPH was greater in those with thrombocytopenia, p < 0.001, but the median difference in QBL in all platelet groups was small. Conclusion We found a statistically significant association between lower predelivery platelet counts and QBL and PPH. The clinical significance of these results is debatable, because at all platelet count ranges, differences in blood loss were small. Key Points

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Section: Discussionmentioning

confidence: 93%

Is There an Association between Platelet Count and Blood Loss in the Parturient? A Retrospective Study

Beilin,

Liu,

Hyers

et al. 2023

Am J Perinatol

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“…A similar finding was reported in previous studies. 31,37,38 For women who had episiotomies, gauze and swabs that were used to hold the wound and absorb the blood before the baby's birth had to be weighed in addition to the maternity pads.…”

Section: Discussionmentioning

confidence: 99%

Gravimetric assessment of postpartum blood loss: training and implementation in a low resource setting

Indrayani¹,

Stacey²,

Merchant³

et al. 2023

AJAN

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Objective: This study aimed to evaluate the training and implementation of the gravimetric method for estimating postpartum blood loss in clinical practice in Indonesian midwife-led birth centres.Background: Postpartum haemorrhage remains a leading cause of maternal death, particularly in low-resource settings. There is no gold standard for assessing blood loss volume during labour and childbirth. Studies recommended using a gravimetric method to measure blood loss in low-resource settings due to its relative accuracy and simplicity. study design and methods: An online training module for the use of the gravimetric method was developed. All participants undertook the training and were asked to implement the method in clinical practice. A pre/post-test study design was used to examine midwives' understanding of the gravimetric method; their implementation experience was explored using a structured questionnaire. Knowledge was assessed pre-training. The training consisted of both theoretical and practical elements and the opportunity for participants to ask questions.Post-training tests were administered, followed by a one-month period of implementation and an evaluation of their experience of using the method in practice. results: Two hundred and eighty-five midwives from 17 health facilities were recruited to the study, and a total of 101 midwives from 12 health facilities completed all elements. The participants' understanding of the gravimetric method improved significantly following the training. Although a number of challenges were identified regarding the implementation of the gravimetric method in practice, the participants were generally positive about its use, and 89% said that they would recommend this method to colleagues. conclusion: A three-hour online training effectively improved participants' understanding of the gravimetric method for assessing blood loss volume. This study identified midwives' positive experiences with the gravimetric method and identified areas to improve practitioner experience of implementation in practice. aUthOrs iNDraYaNi PhD Candidate 1,2

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“…Postpartum hysterectomy and maternal death are the most severe PPH related morbidities [ 35 ]. Our data showed no changes in postpartum hysterectomy, MMR and MMR related to PPH neither in the maternity units where AIP was implemented nor where it was not, but the sample size was not large enough to demonstrate any change in these rare events.…”

Section: Discussionmentioning

confidence: 99%

Effectiveness of emergency obstetric care training at the regional level in Ukraine: a non-randomized controlled trial

Mogilevkina

Гуріанов

Lindmark

2022

BMC Pregnancy Childbirth

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Background Emergency obstetric care training, using Advances in Labour and Risk Management (ALARM) International Program (AIP) was implemented in Ukraine, a country with universal access to skilled perinatal and obstetric care but restricted resources. A total of 577 providers (65.5% of total) from 28 maternal clinics attended a 5-day training session focused on the five main causes of maternal mortality, with hands-on skill workshops, pre- and post- tests, and an objective structured clinical examination. The effects of this emergency obstetric care training on maternal outcomes is the subject of this paper. Methods A non-randomized controlled trial was conducted. The pilot areas where the training was implemented consisted of 64 maternity clinics of which 28 were considered as cases and 36 non-participating clinics were the referents. Data on maternal outcomes were collected for a 2-year span (2004-2005) prior to the trainings, which took place 2006-2007 and again after implementation of the trainings, from 2008 to 2009. Information was collected from 189,852 deliveries. Outcomes for the study were incidences of operative delivery and postpartum hemorrhage. Non-parametric statistics, meta-analyses, and difference in difference (DID) estimation were used to assess the effect of the AIP on maternal indices. Results DID analysis showed that after the training, compared to the referents, the cases had significant reduction of blood transfusions (OR: 0.56; 95%CI: 0.48-0.65), plasma transfusions (OR: 0.70; 95%CI: 0.63-0.78), and uterus explorations (OR: 0.64; 95%CI: 0.59-0.69). We observed a non-significant reduction of postpartum hemorrhage ≥1000 ml (OR: 0.92; 95%CI: 0.81-1.04; P = 0.103). Utilization of vacuum extraction for vaginal delivery increased (OR: 2.86; 95%CI: 1.80-4.57), as well as forceps assisted delivery (OR: 1.80; 95%CI: 1.00-3.25) and cesarean section (OR: 1.11; 95%CI: 1.06-1.17). There was no change in the occurrence of postpartum hysterectomy and maternal mortality. Conclusions After one week of Emergency Obstetrics Care training of the obstetric staff in a setting with universal access to perinatal and obstetric care but restricted resources, an association with the reduction of postpartum hemorrhage related interventions was observed. The effects on the use of vacuum extraction and cesarean section were minimal. Trial registration Retrospectively registered 071212007807 from 07/12/2012.

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Can measuring blood loss at delivery reduce hemorrhage-related morbidity?

Cited by 10 publications

References 72 publications

Is There an Association between Platelet Count and Blood Loss in the Parturient? A Retrospective Study

Is There an Association between Platelet Count and Blood Loss in the Parturient? A Retrospective Study

Gravimetric assessment of postpartum blood loss: training and implementation in a low resource setting

Effectiveness of emergency obstetric care training at the regional level in Ukraine: a non-randomized controlled trial

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