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

Coviello, Elizabeth; Iqbal, Sara; Kawakita, Tetsuya; Chornock, Rebecca L.; Cheney, Megan; Desale, Sameer; Fries, Melissa H.

doi:10.1055/s-0039-1688823

Cited by 15 publications

(13 citation statements)

References 14 publications

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“…Our assumption of a 10% PPH rate was based on a previous study that was conducted from our institution. 17 We suspect that PPH rates were higher in this study than the previous study because we only included women undergoing cesarean delivery, whereas the previous study included women who had vaginal and cesarean deliveries. It is well known that cesarean delivery is associated with an increased risk of PPH compared with vaginal delivery.…”

Section: Results In Contextmentioning

confidence: 83%

“…Data were obtained by chart review and abstraction of outpatient, Labor and Delivery, and anesthesia records. Assuming a 10% rate of PPH 17 and a 10% incidence of mild thrombocytopenia, a total of 2759 women (2508 with normal platelet count and 251 women with mild thrombocytopenia) would be needed to detect 60% difference in the risk of PPH with alpha of 0.05 and beta of 0.80. For statistical analysis, we used the chi-square test to analyze categorical variables and Student's t test or Wilcoxon rank-sum test for continuous variables.…”

Section: Methodsmentioning

confidence: 99%

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Effect of mild preoperative thrombocytopenia on postpartum hemorrhage after cesarean deliveries

DiSciullo

Mokhtari

Landy

et al. 2021

American Journal of Obstetrics & Gynecology MFM

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BACKGROUND: Thrombocytopenia at the time of delivery is considered as a risk factor for postpartum hemorrhage. However, platelet count thresholds for postpartum hemorrhage are variable and not extensively studied. OBJECTIVE: This study aimed to examine whether mild thrombocytopenia is associated with an increased risk of postpartum hemorrhage among women undergoing cesarean delivery. STUDY DESIGN: This was a retrospective cohort study of all women who underwent cesarean delivery at a tertiary care hospital labor and delivery unit from September 2015 to June 2018. Women with normal platelet counts (≥150,000/mL) were compared with women with mild thrombocytopenia (100,000−149,000/mL). Women were excluded if they had moderate to severe thrombocytopenia (platelet count of <100,000/mL) or had received a platelet transfusion. The primary outcome was postpartum hemorrhage (quantitative blood loss of ≥1000 mL). Secondary outcomes included frequencies of red blood cell transfusion, wound complications (surgical site infections, dehiscence, or hematoma), and postpartum emergency department visits. Adjusted odds ratios with 95% confidence intervals were calculated, controlling for maternal age, gestational age, body mass index, scheduled cesarean delivery, hypertension, and preoperative hemoglobin level. RESULTS: Of 3133 women, 2799 (89.3%) had normal platelet levels, 298 (9.5%) had mild thrombocytopenia, and 36 (1.2%) had moderate to severe thrombocytopenia. There were no differences in the risks of postpartum hemorrhage, need for a red blood cell transfusion, wound complications, or postpartum emergency department visit comparing women with normal platelet counts with those with mild thrombocytopenia (24.6% vs 25.8% [adjusted odds ratio, 1.16; 95% confidence interval, 0.88−1.54]; 6.5% vs 6.7% [adjusted odds ratio, 1.34; 95% confidence interval, 0.80−2.24]; 4.5% vs 5.4% [adjusted odds ratio, 1.53; 95% confidence interval, 0.88−2.64]; 9.0% vs 10.7% [adjusted odds ratio, 1.37; 95% confidence interval, 0.92−2.03], respectively). CONCLUSION: Preoperative mild thrombocytopenia was not associated with postpartum hemorrhage, red blood cell transfusion, wound complications, or postpartum emergency department visits in women undergoing cesarean delivery.

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Section: Results In Contextmentioning

confidence: 83%

Section: Methodsmentioning

confidence: 99%

Effect of mild preoperative thrombocytopenia on postpartum hemorrhage after cesarean deliveries

DiSciullo

Mokhtari

Landy

et al. 2021

American Journal of Obstetrics & Gynecology MFM

Self Cite

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“…14 A published review found that bimanual uterine compression could be used to stop or slow bleeding in cases where uterotonics were not effective in stopping PPH. 6,15 WHO recommends uterine compression as a measure to manage blood loss postvaginal delivery until proper medical care and support becomes available. 8…”

Section: Discussionmentioning

confidence: 99%

Effect of Sustained Uterine Compression versus Uterine Massage on Blood Loss after Vaginal Delivery: A Randomized Controlled Trial

et al. 2021

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Objective This study aimed to compare the effectiveness of sustained uterine compression versus uterine massage in reducing blood loos after a vaginal delivery. Study Design This was a prospective randomized trial conducted at the American University of Beirut Medical Center (AUBMC) between October 2015 and October 2017. Inclusion criteria were women with a singleton pregnancy at ≥36 weeks of gestation, with less than three previous deliveries, who were candidates for vaginal delivery. Participants were randomized into two groups, a sustained uterine compression group (group 1) and a uterine massage group (group 2). Incidence of postpartum hemorrhage (blood loss of ≥500 mL) was the primary outcome. We assumed that the incidence of postpartum hemorrhage at our institution is similar to previously published studies. A total of 545 women were required in each arm to detect a reduction from 9.6 to 4.8% in the primary outcome (50% reduction) with a one-sided α of 0.05 and a power of 80%. Factoring in a 10% dropout rate. Secondary outcomes were admission to intensive care unit (ICU), postpartum complications, drop in hemoglobin, duration of hospital stay, maternal pain, use of uterotonics, or of surgical procedure for postpartum hemorrhage. Results A total of 550 pregnant women were recruited, 273 in group 1 and 277 in group 2. There was no statistically significant difference in baseline characteristics between the two groups. Type of anesthesia, rate of episiotomy, lacerations, and mean birth weight were also equal between the groups. Incidence of the primary outcome was not different between the two groups (group 1: 15.5%, group 2: 15.4%; p = 0.98). There was no statistically significant difference in any of the secondary outcomes between the two groups, including drop in hemoglobin (p = 0.79). Conclusion There was no difference in blood loss between sustained uterine compression and uterine massage after vaginal delivery. Key Points

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“…It is worth recognizing that recent publications have highlighted limitations of the clinical utility of QBL to predict change in hemoglobin or need for transfusion, indicating that QBL is not a perfect process or solution. 19,20 The authors would argue that prior works demonstrating the inaccuracy of estimation and the dangers of delay in hemorrhage management greatly outweigh the limitations of QBL. Best practices for transfusion indicate decisions should incorporate real-time measures of hemodynamic stability, such as the vital signs, urine output, and patient's mental status.…”

Section: Discussionmentioning

confidence: 99%

Quantitative Blood Loss (QBL) at every delivery

Rewoldt

Forman

Bowdler

et al. 2019

Proc Obstet Gynecol

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Maternal hemorrhage is a major cause of maternal morbidity and mortality in the United States and efforts are in place to eliminate preventable harm. Accurate assessment of blood lost around the time of birth is essential for timely recognition and intervention. As part of the Alliance for Innovation on Maternal Health (AIM) Obstetrical Hemorrhage Patient Safety Bundle at our institution a quantitative blood loss (QBL) calculator was created within the electronic medical record. This process allows for real-time tracking of cumulative blood loss measurements and is built with triggers to alert the care team when criteria for various hemorrhage stages are achieved along with suggested interventions and assessments. The consistency of implementation and efficacy of the QBL calculator was evaluated by following both utilization of the calculator flowsheet as well as tracking of rates of erroneous QBL values, defined by negative values and cesarean deliveries with QBL2019, 14 months after implementation and post three system-based improvements.By the end of this implementation review the calculator was in use consistently at all cesarean deliveries with improved confidence in the process by providers.

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

Cited by 15 publications

References 14 publications

Effect of mild preoperative thrombocytopenia on postpartum hemorrhage after cesarean deliveries

Effect of mild preoperative thrombocytopenia on postpartum hemorrhage after cesarean deliveries

Effect of Sustained Uterine Compression versus Uterine Massage on Blood Loss after Vaginal Delivery: A Randomized Controlled Trial

Quantitative Blood Loss (QBL) at every delivery

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