Evaluation of measured postpartum blood loss after vaginal delivery using a collector bag in relation to postpartum hemorrhage management strategies: a prospective observational study.
OBJECTIVE
To evaluate the incidence of postpartum hemorrhage (PPH) and severe PPH via routine use of a pelvic drape to objectively measure blood loss after vaginal delivery in connection with PPH management.


METHODS
This prospective observational study was undertaken at the obstetrical department of the Charité University Hospital from December 2011 to May 2013 and evaluated an unselected cohort of planned vaginal deliveries (n=1019 live singletons at term). A calibrated collecting drape was used to meassure blood loss in the third stage of labor. PPH and severe PPH were defined as blood loss ≥500 mL and ≥1000 mL, respectively. Maternal hemoglobin content was evaluated at admission to delivery and at the first day after childbirth.


RESULTS
During the study period, 809 vaginal deliveries were analysed. Direct measurement revealed a median blood loss of 250 mL. The incidences of PPH and severe PPH were 15% and 3%, respectively. Mean maternal hemoglobin content at admission was 11.9±1.1 g/dL, with a mean decrease of 1.0±1.1 g/dL. Blood loss measured after vaginal delivery correlated significantly with maternal hemoglobin decrease.


CONCLUSIONS
This study suggests that PPH incidence may be higher than indicated by population-based data. Underbuttocks drapes are simple, objective bedside tools to diagnose PPH. Blood loss should be quantified systematically if PPH is suspected.
Christian
C
Bamberg
Katja
K
Niepraschk-von Dollen
Laura
L
Mickley
Anne
A
Henkelmann
Larry
L
Hinkson
Lutz
L
Kaufner
Christian
C
von Heymann
Wolfgang
W
Henrich
Franziska
F
Pauly
D000328:Adult; D001800:Blood Specimen Collection / Q000295:instrumentation*; D001810:Blood Volume; D005260:Female; D005858:Germany / Q000453:epidemiology; D006454:Hemoglobins / Q000378:metabolism; D006801:Humans; D015994:Incidence; D006473:Postpartum Hemorrhage / Q000097:blood / Q000175:diagnosis* / Q000453:epidemiology; D011247:Pregnancy; D011446:Prospective Studies; D058636:Surgical Drapes; D055815:Young Adult
D006454:Hemoglobins