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. 2022 Feb 4;12(1):e36-e40.
doi: 10.1055/s-0041-1742267. eCollection 2022 Jan.

Limitations of Gravimetric Quantitative Blood Loss during Cesarean Delivery

Robert L Thurer  1 , Sahar Doctorvaladan  2 , Brendan Carvalho  3 , Andrea T Jelks  4
Affiliations

Limitations of Gravimetric Quantitative Blood Loss during Cesarean Delivery

Robert L Thurer et al. AJP Rep. .

Abstract

Objective This study examined the accuracy, sources of error, and limitations of gravimetric quantification of blood loss (QBL) during cesarean delivery. Study Design Blood loss determined by assays of the hemoglobin content on surgical sponges and in suction canisters was compared with QBL in 50 parturients. Results QBL was moderately correlated to the actual blood loss ( r = 0.564; p < 0.001). Compared with the reference assay, QBL overestimated blood loss for 44 patients (88%). QBL deviated from the assayed blood loss by more than 250 mL in 34 patients (68%) and by more than 500 mL in 16 cases (32%). Assayed blood loss was more than 1,000 mL in four patients. For three of these patients, QBL was more than 1,000 mL (sensitivity = 75%). QBL was more than 1,000 mL in 12 patients. While three of these had an assayed blood loss of more than 1,000 mL, 9 of the 46 patients with blood losses of less than 1,000 mL by the assay (20%) were incorrectly identified as having postpartum hemorrhage by QBL (false positives). The specificity of quantitative QBL for detection of blood loss more than or equal to 1,000 mL was 80.4%. Conclusion QBL was only moderately correlated with the reference assay. While overestimation was more common than underestimation, both occurred. Moreover, QBL was particularly inaccurate when substantial bleeding occurred. Key Points QBL is inaccurate in cesarean delivery.QBL deviated from the assay result by more than 500 mL in 32% of cases.QBL sensitivity and specificity for hemorrhage is 75.0% (95% confidence interval [CI]: 0.19-0.93) and 80.4% (95% CI: 0.69-0.92), respectively.

Keywords: blood loss quantification; cesarean delivery; postpartum hemorrhage; quality improvement.

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Conflict of interest statement

Conflict of Interest None declared.

Figures

Fig. 1
Fig. 1
Assessment of agreement between gravimetric QBL and the extraction assay method according to the Bland–Altman method. QBL, quantification of blood loss.
Fig. 2
Fig. 2
Assayed blood loss versus gravimetric QBL with Passing–Bablock regression line. QBL, quantification of blood loss.
Fig. 3
Fig. 3
Difference in canister volume (post–pre) versus irrigation volume (mL) with Thiel regression line.
See this image and copyright information in PMC

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