Improved accuracy of postpartum blood loss estimation as assessed by simulation.
OBJECTIVE
Caregivers underestimate the amount of blood loss, but this almost five decades-old assumption has not been validated. We aimed at assessing the accuracy of estimated blood loss by obstetrical teams during a simulated Postpartum hemorrhage (PPH) scenario.


METHODS
a prospective study conducted as part of the simulation-based training course, using sophisticated mannequin simulators adapted for obstetrical training by specially designed devices.


METHODS
Part of the simulation-based training course.


METHODS
Obstetrical teams consisted of physicians and obstetrical nurses.


METHODS
Each of the participating obstetrical teams assessed blood loss during PPH scenarios. Their estimates were compared to the actual predefined 3.5-liter blood loss. An intervention group underwent a similar course in which they recorded their estimations after 1, 2 and 3.5 liters were lost.


METHODS
Blood loss estimates after completion of the scenario in both groups.


RESULTS
Fifty obstetrical teams took part in the study. Eight comprised the interventional group. The average estimated blood loss was 1,780 ml (49% underestimation) for non-interventional teams. The interventional groups estimated blood loss to be 2,400 ml (32% underestimation). The main method of estimating blood loss was 'gut feeling', followed by verbalized guesses of team members and assessments of the 'patient's' hemodynamic status.


CONCLUSIONS
Accuracy of blood loss estimations by a simulation-based PPH scenario was 50-60%. Measurements at predetermined intervals significantly improved accuracy of these estimations. Our study suggests that implementation of periodic estimations of blood loss in the management of PPH might improve clinical judgment.
Maslovitz
Sharon
S
Tel-Aviv Sourasky Medical Center, Lis Maternity Hospital, Tel-Aviv, Israel. maslovitz@gmail.com
Barkai
Gad
G
Lessing
Joseph B
JB
Ziv
Amitai
A
Many
Ariel
A
D003198:Computer Simulation; D003194:Computer-Assisted Instruction; D005260:Female; D006801:Humans; D008297:Male; D008348:Manikins; D009774:Obstetrics / Q000193:education*; D010820:Physicians; D006473:Postpartum Hemorrhage / Q000097:blood* / Q000175:diagnosis*; D011446:Prospective Studies