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Grand Rounds

A Quantitative Method to Better Estimate of Blood Loss During Cesarean

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BACKGROUND AND PURPOSE:

  • Triton system (Gauss Surgical, Inc, Los Altos, CA)
    • Quantitative method to determine estimated blood loss (EBL)
    • Uses imaging (iPad-based app) to quantify hemoglobin mass absorbed by surgical sponges
    • Approved by FDA but no validation studies in an OB population
  • Saoud et al. (AJOG, 2019) compared the Triton system vs other methods to estimate EBL at time of cesarean delivery

METHODS:

  • Single-center, prospective cohort study
  • Participants
    • Women scheduled for cesarean delivery
  • Methods and study design
    • EBL measured using two methods
      • Triton (masked to the clinical team)
      • Subjective estimate by the surgeon
  • Data analysis
    • The 2 different approaches were compared in women with delta (change in) hemoglobin in the upper quartile (cases) vs all other quartiles (control)
    • Delta hemoglobin: Difference between preoperative Hgb and Hgb on postop day 1
    • Prediction of delta hemoglobin in the upper quartile was evaluated for each method, and the area under the receiver operating characteristic (ROC) curves was compared
    • Statistical analysis done independent of company

RESULTS:

  • 232 patients | 70 patients with delta hemoglobin in the upper quartile (delta hemoglobin ≥2)
  • Triton: Mean EBL significantly lower than what was estimated by clinical judgement (p<0.01)
    • Triton estimation: 415.3±260.6 mL
    • Subjective estimation: 799.6±215.6 mL
  • Triton
    • Was more tightly correlated with delta hemoglobin
    • Unlike subjective EBL, was predictive of delta hemoglobin ≥2 g/dL
  • ROC curves
    • Triton: 0.66 (95% CI, 0.58 to 0.74; P<.01)
    • Subjective estimation: 0.53 (95% CI, 0.45 to 0.61; P=.45)

CONCLUSION:

  • Triton system provides a better EBL following cesarean than subjective assessment
  • Further studies required
    • EBL in this study well below definition of PPH
    • Clinical utility studies to determine impact on outcomes  

Learn More – Primary Sources:

Validation of a new method to assess estimated blood loss in the obstetric population undergoing cesarean delivery

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