Visual estimation versus gravimetric measurement of postpartum blood loss: a prospective cohort study.
OBJECTIVE
One of the major problems in international literature is how to measure postpartum blood loss with accuracy. We aimed in this research to assess the accuracy of visual estimation of postpartum blood loss (by each of two main health-care providers) compared with the gravimetric calculation method.


METHODS
We carried out a prospective cohort study at King Abdulaziz Medical City, Riyadh, Saudi Arabia between 1 November 2009 and 31 December 2009. All women who were admitted to labor and delivery suite and delivered vaginally were included in the study. Postpartum blood loss was visually estimated by the attending physician and obstetrics nurse and then objectively calculated by a gravimetric machine. Comparison between the three methods of blood loss calculation was carried out.


RESULTS
A total of 150 patients were included in this study. There was a significant difference between the gravimetric calculated blood loss and both health-care providers' estimation with a tendency to underestimate the loss by about 30%. The background and seniority of the assessing health-care provider did not affect the accuracy of the estimation. The corrected incidence of postpartum hemorrhage in Saudi Arabia was found to be 1.47%.


CONCLUSIONS
Health-care providers tend to underestimate the volume of postpartum blood loss by about 30%. Training and continuous auditing of the diagnosis of postpartum hemorrhage is needed to avoid missing cases and thus preventing associated morbidity and mortality.
Department of Obstetrics and Gynecology, King Abdulaziz Medical City, King Saud Bin Abdulaziz University for Health Sciences, College of Medicine, Riyadh, Saudi Arabia. halkadri@gmail.com
Hanan M F
HM
Al Kadri
Bedayah K
BK
Al Anazi
Hani M
HM
Tamim
D000328:Adult; D001810:Blood Volume; D015331:Cohort Studies; D005260:Female; D006452:Hemoglobinometry; D006801:Humans; D015588:Observer Variation; D006473:Postpartum Hemorrhage / Q000097:blood / Q000175:diagnosis*; D011237:Predictive Value of Tests; D011247:Pregnancy; D011446:Prospective Studies; D055815:Young Adult