Grand Rounds

A Quantitative Method to Better Estimate of Blood Loss During Cesarean

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

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

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)

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

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