Clinical Experience with the Implementation of Accurate Measurement of Blood Loss during Cesarean Delivery: Influences on Hemorrhage Recognition and Allogeneic Transfusion
10 August 2017
15 November 2017
05 December 2017 (eFirst)
Objective This article compares hemorrhage recognition and transfusion using accurate, contemporaneous blood loss measurement versus visual estimation during cesarean deliveries.
Study Design A retrospective cohort study using visually estimated blood loss (traditional, n = 2,025) versus estimates using a mobile application that photographs sponges and canisters and calculates their hemoglobin content (device, n = 756).
Results Blood loss > 1,000 mL was recognized in 1.9% of traditional visual estimation patients, while measured blood loss of > 1,000 mL occurred in 8.2% of device patients (p < 0.0001). In both groups, this was accompanied by a greater decrease in transfusion-adjusted hemoglobin levels than occurred in patients without hemorrhage (p < 0.0001). Despite similar transfusion rates (1.6% in both groups), fewer red cell units were given to transfused patients in the device group (1.83 ± 0.58 versus 2.56 ± 1.68 units; p = 0.038). None of the patients in the device group received plasma or cryoprecipitate. Seven patients in the traditional group received these products (p = 0.088). Device use was associated with shorter hospital stays (4.0 ± 2.3 versus 4.4 ± 2.9 days; p = 0.0006).
Conclusion The device identified hemorrhages more frequently than visual estimation. Device-detected hemorrhages appeared clinically relevant. Blood product transfusion was reduced possibly due to earlier recognition and treatment, although further studies are needed to verify the conclusion.
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