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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