Quantification of Blood Loss Improves Detection of Postpartum Hemorrhage and Accuracy of Postpartum Hemorrhage Rates: A Retrospective Cohort Study

Blosser, Colleen; Smith, Alisha M; Poole, Aaron

doi:10.7759/cureus.13591

Cited by 11 publications

(8 citation statements)

References 10 publications

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“…Estimated blood loss is less reliable than quantitative blood loss assessment and likely underestimates total blood loss volume. 24 Similarly, institutional protocols for ICU admission and transfusion likely varied. Missing data are a challenge with all real-world data collection.…”

Section: Discussionmentioning

confidence: 99%

Real-World Utilization of an Intrauterine, Vacuum-Induced, Hemorrhage-Control Device

Goffman,

Rood,

Bianco

et al. 2023

Obstetrics &Amp; Gynecology

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OBJECTIVE: To assess the real-world effectiveness and safety of a U.S. Food and Drug Administration (FDA)–cleared intrauterine vacuum-induced-hemorrhage control device for postpartum hemorrhage (PPH) management. METHODS: Sixteen centers in the United States participated in this observational, postmarket registry medical record review (October 2020 through March 2022). The primary effectiveness outcome was treatment success, defined as bleeding control after insertion with no treatment escalation or bleeding recurrence. Additional outcomes included blood loss, time to device insertion, indwelling time, bleeding recurrence, and time to bleeding control. Treatment success and severe maternal morbidity measures (transfusion of 4 or more units of red blood cell, intensive care unit admission, and hysterectomy) were evaluated by blood loss before insertion. To assess safety, serious adverse events (SAEs) and adverse device effects were collected. All outcomes were summarized by mode of delivery; treatment success was summarized by bleeding cause (all causes, any atony, isolated atony, nonatony). RESULTS: In total, 800 individuals (530 vaginal births, 270 cesarean births) were treated with the device; 94.3% had uterine atony (alone or in combination with other causes). Median total blood loss at device insertion was 1,050 mL in vaginal births and 1,600 mL in cesarean births. Across all bleeding causes, the treatment success rate was 92.5% for vaginal births and was 83.7% for cesarean births (95.8% [n=307] and 88.2% [n=220], respectively, in isolated atony). Median indwelling time was 3.1 hours and 4.6 hours, respectively. In vaginal births, 14 SAEs were reported among 13 individuals (2.5%). In cesarean births, 22 SAEs were reported among 21 individuals (7.8%). Three (0.4%) SAEs were deemed possibly related to the device or procedure. No uterine perforations or deaths were reported. CONCLUSION: For both vaginal and cesarean births in real-world settings, rapid and effective bleeding control was achieved with an FDA-cleared intrauterine vacuum-induced hemorrhage-control device. The safety profile was consistent with that observed in the registrational trial (NCT02883673), and SAEs or adverse device effects were of the nature and severity expected in the setting of PPH. This device is an important new tool for managing a life-threatening condition, and timely utilization may help to improve obstetric hemorrhage outcomes. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov, NCT04995887.

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Section: Discussionmentioning

confidence: 99%

Real-World Utilization of an Intrauterine, Vacuum-Induced, Hemorrhage-Control Device

Goffman,

Rood,

Bianco

et al. 2023

Obstetrics &Amp; Gynecology

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“…14,15 Blosser et al showed QBL is a more sensitive test for detecting clinically significant blood loss that could lead to an earlier diagnosis and treatment of PPH. 16 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.…”

Section: Discussionmentioning

confidence: 99%

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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“…Fourth, we did not have information about the emergent nature of cesarean births, which could predict heightened perception of trauma (Burcher et al 2020;Stoll et al 2018;Wada et al 2019). Fifth, medical record data were entered by multiple physicians, nurse practitioners, or certified nurse midwifes, with the potential for inaccuracy, particularly in estimating blood loss (Blosser et al 2021). Future efforts that use formal quantification methods are warranted to generate more precise blood loss estimates that are associated with increased risk for trauma and/or PPD (Blosser et al 2021).…”

Section: Discussionmentioning

confidence: 99%

Clinician-reported childbirth outcomes, patient-reported childbirth trauma, and risk for postpartum depression

Waller

Kornfield

White

et al. 2022

Arch Womens Ment Health

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Childbirth trauma is common and increases risk for postpartum depression (PPD). However, we lack brief measures to reliably identify individuals who experience childbirth trauma and who may be at greater prospective risk for PPD. To address this gap, we used data from a racially diverse prospective cohort ( n= 1082). We collected survey data during pregnancy and at 12 weeks postpartum, as well as clinician-reported data from medical records. A new three-item measure of patient-reported childbirth trauma was a robust and independent risk factor for PPD, above and beyond other known risk factors for PPD, including prenatal anxiety and depression. Cesarean birth, greater blood loss, and preterm birth were each associated with greater patient-reported childbirth trauma. Finally, there were prospective indirect pathways whereby cesarean birth and higher blood loss were related to higher patient-reported childbirth trauma, in turn predicting greater risk for PPD. Early universal postpartum screening for childbirth trauma, targeted attention to individuals with childbirth complications, and continued screening for depression and anxiety can identify individuals at risk for PPD. Such efforts can inform targeted interventions to improve maternal mental health, which plays a vital role in infant development. Supplementary Information The online version contains supplementary material available at 10.1007/s00737-022-01263-3.

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Quantification of Blood Loss Improves Detection of Postpartum Hemorrhage and Accuracy of Postpartum Hemorrhage Rates: A Retrospective Cohort Study

Cited by 11 publications

References 10 publications

Real-World Utilization of an Intrauterine, Vacuum-Induced, Hemorrhage-Control Device

Real-World Utilization of an Intrauterine, Vacuum-Induced, Hemorrhage-Control Device

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

Clinician-reported childbirth outcomes, patient-reported childbirth trauma, and risk for postpartum depression

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