University of Wisconsin–Madison ⋅ Medical College of Wisconsin
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Assessing Accuracy of Blood Loss Measurements During Cesarean Birth in a Diverse Patient Population: A Quality Improvement Study

Jessica J. F. Kram, MPH; Yuri Zermeno, MD; James O. Adefisoye, MS; Elizabeth Dickson Michelson, MD; Emily Malloy, PhD, CNM; Nicole Salvo, MD

WMJ. 2024;123(6):483-486.

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ABSTRACT

Background: Accurate measurement of blood loss during delivery is important for early hemorrhage detection.

Methods: We compared quantitative blood loss and estimated blood loss to calculated blood loss. We reviewed cesarean deliveries for estimated blood loss and quantitative blood loss, December 1, 2018, to December 1, 2019. A standard formula was used for calculated blood loss.

Results: Overall (n = 483), median values (m; interquartile range [IQR]) for estimated blood loss (600.0 mL; IQR 500.0–800.0) and quantitative blood loss (557.0 mL; IQR 350.0 – 824.0) were significantly lower (both P values < 0.001) than calculated blood loss (929.4 mL; IQR 551.5 – 1351.5). Compared to calculated blood loss, both estimated blood loss and quantitative blood loss had low sensitivity, high specificity, and low negative predictive values. Only 10 additional patients were identified as having a postpartum hemorrhage through quantitative blood loss.

Discussion: Quantitative blood loss and estimated blood loss are immediately available in clinical practice, while calculated blood loss is not and requires additional time to obtain. All methods currently available have shortcomings. Continued efforts to create a reliable tool for identifying blood loss are needed.

Author Affiliations: Academic Affairs, Aurora University of Wisconsin Medical Group, Advocate Health, Aurora Sinai Medical Center, Milwaukee, Wisconsin (Kram, Adefisoye); Center for Urban Population Health, Milwaukee, Wisconsin (Kram); Department of Obstetrics and Gynecology, Advocate Health, Aurora Sinai Medical Center, Milwaukee, Wisconsin (Zermeno, Salvo); Department of Oncology, Advocate Health, Aurora West Allis Medical Center, Milwaukee, Wisconsin (Dickson Michelson); Department of Obstetrics and Gynecology and Midwifery, Aurora University of Wisconsin Medical Group, Advocate Health, Aurora Sinai Medical Center, Milwaukee, Wisconsin (Malloy).
Corresponding Author: Jessica J. F. Kram, MPH; 1020 N 12th St, Suite 4180, Milwaukee, WI 53233; phone 414.219.5594; email jessica.kram@aah.org; ORCID ID 0000-0001-9831-7353
Financial Disclosures: None declared.
Funding/Support: None declared.
Previous Presentations: Some of this work was submitted as an abstract for presentation at the 2022 Annual Clinical and Scientific Meeting of the American College of Obstetricians and Gynecologists on May 6-8, 2022, in San Diego, California. Some of this work also was presented internally.
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