ACOG Guidance on Quantification of Blood Loss During OB Hemorrhage
ACOG released new guidance (Nov 2019) on quantification of blood loss during an obstetrical hemorrhage. While there are multiple recommendations, a central theme of the document is that accuracy of quantitative measurement is superior to visual estimation. A multidisciplinary approach is recommended and in addition
Implementation of quantitative assessment of blood loss includes the following two items: 1) use of direct measurement of blood loss (quantitative blood loss) and 2) protocols for collecting and reporting a cumulative record of blood loss postdelivery
How to Quantify Blood Loss (AWHONN Practice Brief)
Vaginal Delivery: Use under-buttocks drape
Begin quantification following delivery (i.e., prior to placental delivery) | Most fluid prior to delivery include amniotic fluid, urine and feces
Record total fluid volume
Subtract preplacental fluid from post placental fluid volume | Most fluid following delivery is blood
Calculate blood volume from soaked items by subtracting weight of wet item from that of dry (1 g additional weight equals 1 ml blood loss)
Cumulative volume: Calculated blood volume from weighted soaked items plus drape volume
Cesarean delivery: Use suction device
Begin quantification when (1) amniotic sac ruptured or (2) after birth
Suction and quantify amniotic fluid prior to placental delivery
Quantify blood in suction cannister and drapes after delivery of the placenta
Weigh all soaked items as above
Cumulative volume: Calculated blood volume from weighted soaked items plus blood in suction canister
Visual estimation of blood loss can result in both over and underestimation
While quantification of blood loss in an important part of evidence based hemorrhage bundles, clinical utility specific to the quantification approach remains unproven and more research is needed
Timeframe for continuing blood loss assessment
Evidence is insufficient to recommend a precise time frame for ongoing measurement
ACOG suggests “that ongoing blood loss assessment should continue as long as active bleeding is present, or as long as the patient is unstable after a blood loss of more than 1,000 mL, including the postpartum care setting”
New Approaches: Artificial intelligence platforms
Artificial intelligence-based algorithms that use colorimetric analyses of pictures to quantify blood loss in real-time appear promising
ACOG states that while there is some supportive data, “validation of these findings with additional research is needed”
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