Accuracy of blood loss estimation at caesarean delivery
Keywords:
Blood loss, estimation, caesarean delivery, haemoglobin concentrationAbstract
Objective: Inaccurate estimation of blood loss during caesarean delivery may be associated with inappropriate decisions in transfusing patients and this may lead to increased maternal morbidity. The study aimed at comparing the accuracy of blood loss estimation by obstetricians and anaesthetists at caesarean delivery.
Methods: This was a cross-sectional retrospective study of 153 women who had caesarean delivery. The anaesthetists and obstetricians involved in the deliveries independently estimated blood loss. The preoperative and 48-hour postoperative haemoglobin concentration values were used to calculate the actual blood loss. The difference in mean blood loss estimates between anaesthetist and obstetricians, and the calculated blood loss was assessed using paired sample t-test. P-value less than 0.05 was deemed statistically significant.
Results: Blood loss estimates by anaesthetists and obstetricians were inaccurate in 78.4% and 80.4% of cases respectively. There was statistically significant difference between blood loss estimates by obstetricians when compared to calculated blood loss (t-test = -2.578; p = 0.011). However, there was no statistically significant difference between blood loss estimates by anaesthetists when compared to calculated blood loss (t-test = -1.665; p = 0.098).
Conclusion: Visual estimation of blood loss at time of caesarean delivery is commonly inaccurate especially at extremes of blood loss. Intra-operative blood loss estimates by anaesthetists correlated better with actual blood loss than estimates by obstetricians.
References
Ashrat AH, Ramadani HM. Assessment of blood loss during caesarean section under general anaesthesia and epidural analgesia using different methods. Alexandria Journal of anaethesia and Intensive Care 2006; 9(1): 2534.
Beattie WS, Karbouti K, Wijeysundera DN, Tait G. Risk associated with pre-operative anaemia in noncardiac surgery: a single centre cohort study. Anaesthesiology 2009; 110: 574581.
Bose P, Regan F, Paterson-brown S. Improving the accuracy of estimated blood loss at obstetric haemorrhage using clinical reconstructions. British Journal of Obstetrics and Gynaecology 2006; 113(8): 919-24.
Chua S, Ho LM, Vanaja K, Nordstrom L, Roy AC, Arulkumaran S. Validation of a laboratory method of measuring postpartum blood loss. Gynecologic and Obstetric Investigation 1998; 46:31-3.
Dodson MK, Magann EF, Chauhan SP, Harris
RL, Martin JN, Morrison JC. Accuracy of Blood loss estimation and measurement at section. American Journal of Obstetrics and caesarean birth. The Journal of Maternal-Fetal Gynecology 1959; 77:772-779.
& Neonatal Medicine 1994; 3: 171-174. 17. Young W, Karavolos S, Damodaram M, 6. Duthie SJ, Ven D, Yung GL, Guang DZ, Chan Madgwick K, Milestone N, Al-Habib A et al. SY, Ma HK. Discrepancy between laboratory Observer accuracy and reproducibility of determination and visual estimation of blood visual estimation of blood loss in obstetrics: loss during normal delivery. European Journal how accurate and consistent are health-care of Obstetrics Gynecology and Reproductive professionals? Archives of Gynecology and Biology 1991; 38(2): 119-24. Obstetrics 2010; 281(2): 207-13.
Elzik ME, Dirschl DR, Dahners LE.
Correlation of transfusion volume to change in haematocrit. American Journal of Hematology 2006; 81: 145-146.
Haswell JN. Measured blood loss at delivery. The Journal of the Indiana State Medical Association 1981; 74:34-6.
Larsson C, Saltvedt S, Wiklund I, Pahlen S, Andolf E. Estimation of blood loss after caesarean section and vaginal delivery has low validity with tendency to exaggeration. Acta Obstetricia et Gynecologica 2006; 85: 14481452.
Maslovitz S, Barkai G, Lessing JB, Ziv A, Many A. Improved accuracy of postpartum blood loss estimation as assessed by stimulation. Acta Obstetricia et Gynecologica 2008; 87: 929-934.
Nelston GH, Ashford C, Williamson R,
Amburn SD. Method for calculating blood loss at vaginal delivery. Southern Medical Journal 1981; 74:550-2.
Ramadani H. Caesarean section: intraoperative blood loss and mode of placenta separation. International Journal of Gynecology and Obstetrics 2004; 87(2): 114-8.
Razvi K, Chua S, Arulkumaran S, Ratnam SS. A comparison between visual estimation and laboratory determination of blood loss during the third stage of labour. The Australian and New Zealand Journal of Obstetrics and Gynaecology 1996; 36: 152-4.
Solon JG, Egan C, McNamara DA. Safe surgery: how accurate are we at predicting intra-operative blood loss. Journal of Evaluation in Clinical Practice 2013; 19(1): 100-5.
Villeneuve MG, Khalife S, Marcoux S. Surgical staples in caesarean section: a randomized controlled trial. American Journal of Obstetrics and Gynecology 1990; 163(5pt1): 1641-6.
Wilcox CF, Hunt AB, Owen CA. The measurement of blood lost during caesarean
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