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ONGOING COLUMNS: Hot Topics in Maternity Nursing

Measuring Blood Loss in Obstetric Hemorrhage

Wisner, Kirsten PhD, RNC-OB, CNS, C-EFM

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MCN, The American Journal of Maternal/Child Nursing: May/June 2020 - Volume 45 - Issue 3 - p 184
doi: 10.1097/NMC.0000000000000616
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Obstetric (OB) hemorrhage is a major contributor to maternal morbidity and mortality (~11% of U.S. maternal deaths). Death from OB hemorrhage is considered largely preventable. Accurate measurement of blood loss is important to identify women experiencing a hemorrhage (American College of Obstetricians and Gynecologists [ACOG], 2019; Association of Women's Health, Obstetric, and Neonatal Nurses [AWHONN], 2015). Quantification of blood loss (QBL) leads to earlier detection of hemorrhage; however, evidence on QBL improving clinical outcomes such as the need for blood transfusion, plasma expanders, or uterotonics is lacking (Diaz, Abalos, & Carroli, 2018). Use of a statewide OB hemorrhage bundle reduced severe maternal morbidity in women experiencing OB hemorrhage (Main et al., 2017).

Visual estimation leads to overestimation of blood loss when volumes are low and underestimation when volumes are high; hence, both ACOG (2019) and AWHONN (2015) recommend QBL instead of visual estimation (EBL) for all births. This should be implemented as part of a hemorrhage bundle. To implement QBL, create a resource for clinicians that provides a list of the dry weights for items used during birth (such as lap sponges, underbuttocks drapes, etc.), directions on how to calculate blood loss, and a scale to measure saturated items and calibrated underbuttocks drapes. The technique for QBL is outlined in the table.

Table
Table

Perinatal nurses can promote safer care by advocating for policies supporting QBL and an OB hemorrhage bundle. For more information, AWHONN and ACOG have online resources specific to postpartum hemorrhage including how to implement QBL.

References

American College of Obstetricians and Gynecologists. (2019). Quantitative blood loss in obstetric hemorrhage (ACOG Committee Opinion No. 794). Obstetrics & Gynecology, 134(6), e150–e156. doi:10.1097/AOG.0000000000003564
Association of Women's Health, Obstetric, and Neonatal Nurses. (2015). Quantification of blood loss: (Practice Brief No. 1). Journal of Obstetric, Gynecologic, and Neonatal Nursing, 44(1), 158–160. doi:10.1111/1552-6909.12519
Diaz V., Abalos E., Carroli G. (2018). Methods for blood loss estimation after vaginal birth. The Cochrane Database of Systematic Reviews, 9, CD010980. doi:10.1002/14651858.CD010980.pub2
Main E. K., Cape V., Abreo A., Vasher J., Woods A., Carpenter A., Gould J. B. (2017). Reduction of severe maternal morbidity from hemorrhage using a state perinatal quality collaborative. American Journal of Obstetrics & Gynecology, 216(3), 298.e1–298.e11. doi:10.1016/j.ajog.2017.01.017
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