CC BY-NC-ND 4.0 · AJP Rep 2022; 12(01): e36-e40
DOI: 10.1055/s-0041-1742267
Original Article

Limitations of Gravimetric Quantitative Blood Loss during Cesarean Delivery

Robert L. Thurer
1   Medical Division, Gauss Surgical, Inc., Menlo Park, California
Sahar Doctorvaladan
2   Department of Obstetrics and Gynecology, Santa Clara Valley Medical Center, San Jose, California
Brendan Carvalho
3   Division of Obstetric Anesthesia, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California
Andrea T. Jelks
4   Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Santa Clara Valley Medical Center, San Jose, California
› Author Affiliations
Funding Gauss Surgical, Inc. supplied statistical support for the study. Gauss personnel (R.L.T.) also participated in study design, data collection, data analysis, and article preparation.


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.

Publication History

Received: 16 June 2020

Accepted: 02 November 2021

Article published online:
04 February 2022

© 2022. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (

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