Maternal and Child Health Journal

, Volume 21, Issue 3, pp 516–523 | Cite as

Diagnosing Postpartum Hemorrhage: A New Way to Assess Blood Loss in a Low-Resource Setting

  • Lorine Wilcox
  • Chethan Ramprasad
  • Amanda Gutierrez
  • Maria Oden
  • Rebecca Richards-Kortum
  • Haleh Sangi-Haghpeykar
  • Manisha Gandhi
Article

Abstract

Introduction Postpartum hemorrhage (PPH) is the leading cause of maternal mortality worldwide. The largest barriers to treating PPH are symptom recognition and timely diagnosis. The SAPHE (Signaling a Postpartum Hemorrhage Emergency) Mat was constructed so that each square on the Mat absorbs up to 50 mL of blood. The objective of this study was to evaluate the correlation of visually estimated blood loss (EBL) using the SAPHE Mat with actual blood loss. Methods Thirty-six patients gave birth via vaginal delivery using the SAPHE Mat. Visual estimation of blood loss using the SAPHE Mat was calculated by multiplying the number of blood- saturated squares or partial squares by 50 mL. The visual EBL was compared with the actual blood loss calculated based on Mat weight before and after use (volume blood loss). Results Visual blood loss estimations were within 100 mL of the volume blood loss 69 % of the time and within 200 mL 97 % of the time. The mean difference between the visual EBL and volume blood loss (Mat weight change) was 80.91 mL. The Pearson correlation coefficient for visual EBL and volume blood loss was positive at 0.96 (p < 0.001). Discussion The SAPHE Mat is able to provide a visual estimate of blood loss that is highly correlated with the actual blood loss on the mat. Future studies will assess the ability to deploy the SAPHE Mat in low-resource settings as a potential guide for estimating blood loss to assist in improved management of PPH.

Keywords

Estimated blood loss Postpartum hemorrhage SAPHE Mat Vaginal delivery Low-resource setting 

References

  1. Al Kadri, H. M., Al Anazi, B. K., & Tamim, H. M. (2011). Visual estimation versus gravimetric measurement of postpartum blood loss: A prospective cohort study. Archives of Gynecology and Obstetrics, 283(6), 1207–1213. doi:10.1007/s00404-010-1522-1.CrossRefPubMedGoogle Scholar
  2. American College of Obstetricians and Gynecologists. (2006). ACOG practice bulletin: Clinical management guidelines for obstetrician-gynecologists Number 76, October 2006: Postpartum hemorrhage. Obstetrics and Gynecology, 108(4), 1039.CrossRefGoogle Scholar
  3. Berg, C. J., Harper, M. A., Atkinson, S. M., Bell, E. A., Brown, H. L., Hage, M. L., et al. (2005). Preventability of pregnancy-related deaths: Results of a state-wide review. Obstetrics and Gynecology, 106(6), 1228–1234. doi:10.1097/01.aog.0000187894.71913.e8 CrossRefPubMedGoogle Scholar
  4. Bose, P., Regan, F., & Paterson-Brown, S. (2006). Improving the accuracy of estimated blood loss at obstetric haemorrhage using clinical reconstructions. BJOG: An International Journal of Obstetrics and Gynaecology, 113(8), 919–924. doi:10.1111/j.1471-0528.2006.01018.CrossRefGoogle Scholar
  5. Creinin, M. D., Shore, E., Balasubramanian, S., & Harwood, B. (2005). The true cost differential between mifepristone and misoprostol and misoprostol-alone regimens for medical abortion. Contraception, 71(1), 26–30. doi:10.1016/j.contraception.2004.07.011.CrossRefPubMedGoogle Scholar
  6. Dabash, R., Blum, J., Raghavan, S., Anger, H., & Winikoff, B. (2012). Misoprostol for the management of postpartum bleeding: A new approach. International Journal of Gynecology and Obstetrics, 119(3), 210–212. doi:10.1016/j.ijgo.2012.08.005.CrossRefPubMedGoogle Scholar
  7. Hirayama, F., Koyanagi, A., Mori, R., Zhang, J., Souza, J. P., & Gülmezoglu, A. M. (2012). Prevalence and risk factors for third- and fourth-degree perineal lacerations during vaginal delivery: A multi-country study. BJOG: An International Journal of Obstetrics and Gynaecology 119(3), 340–347. doi:10.1111/j.1471-0528.2011.03210.CrossRefGoogle Scholar
  8. Johar, R. S., & Smith, R.P. (1993). Assessing gravimetric estimation of intraoperative blood loss. Journal of Gynecologic Surgery, 9(3), 151–154. doi:10.1089/gyn.1993.9.151.CrossRefPubMedGoogle Scholar
  9. Leveno, K. J., Cunningham, F. G., Gant, N. F., et al. (2003). In A. Syder, M. Loeb, & P. J. Boyle (Eds.), Williams manual of obstetrics (1st ed., pp. 192–194). New York: McGraw-Hill.Google Scholar
  10. Lewis, G. (2007). Saving mothers’ lives: Reviewing maternal deaths to make motherhood safer—2003–2005. The seventh report of the confidential enquiries into maternal deaths in the United Kingdom. CEMACH. Google Scholar
  11. Lilley, G., Burkett-St-Laurent, D., Precious, E., Bruynseels, D., Kaye, A., Sanders, J., et al. (2015). Measurement of blood loss during postpartum haemorrhage. International Journal of Obstetric Anesthesia, 24(1), 8–14. doi:10.1016/j.ijoa.2014.07.009.CrossRefPubMedGoogle Scholar
  12. Nathan, H., Ayadi, A. E., Hezelgrave, N., Seed, P., Butrick, E., Miller, S., et al. (2015). Shock index: An effective predictor of outcome in postpartum haemorrhage? BJOG: An International Journal of Obstetrics and Gynaecology, 122(2), 268–275. doi:10.1111/1471-0528.13206.CrossRefGoogle Scholar
  13. Nelson, B. D., Stoklosa, H., Ahn, R., Eckardt, M. J., Walton, E. K., & Burke, T. F. (2013). Use of uterine balloon tamponade for control of postpartum hemorrhage by community-based health providers in South Sudan. International Journal of Gynecology and Obstetrics, 122(1), 27–32. doi:10.1016/j.ijgo.2013.02.017 CrossRefPubMedGoogle Scholar
  14. Prasertcharoensuk, W., Swadpanich, U., & Lumbiganon, P. (2000). Accuracy of the blood loss estimation in the third stage of labor. International Journal of Gynecology and Obstetrics, 71(1), 69–70. doi:10.1016/s0020-7292(00)00294-0.CrossRefPubMedGoogle Scholar
  15. Prata, N., Mbaruku, G., Campbell, M., Potts, M., & Vahidnia, F. (2005). Controlling postpartum hemorrhage after home births in Tanzania. International Journal of Gynaecology and Obstetrics, 90(1), 51–55. doi:10.1016/j.ijgo.2005.03.007.CrossRefPubMedGoogle Scholar
  16. Prata, N., Quaiyum, M. A., Passano, P., Bell, S., Bohl, D. D., Hossain, S., et al. (2012). Training traditional birth attendants to use misoprostol and an absorbent delivery mat in home births. Social Science and Medicine, 75(11), 2021–2027. doi:10.1016/j.socscimed.2012.06.028.CrossRefPubMedGoogle Scholar
  17. Raghavan S., Geller S., Miller S., Goudar S. S., Anger H., Yadavannavar M. C., et al. (2015). Misoprostol for primary versus secondary prevention of postpartum haemorrhage: A cluster-randomised non-inferiority community trial. BJOG: An International Journal of Obstetrics and Gynaecology, 123(1), 120–127. doi:10.1111/1471-0528.13540.CrossRefGoogle Scholar
  18. Razvi, K., Chua, S., Arulkumaran, S., & Ratnam, S. S. (1996). A comparison between visual estimation and laboratory determination of blood loss during the third stage of labour. Australian and New Zealand Journal of Obstetrics and Gynaecology, 36(2), 152–154. doi:10.1111/j.1479-828x.1996.tb03273.x.CrossRefPubMedGoogle Scholar
  19. Schorn, M. N. (2010). Measurement of blood loss review of the literature. Journal of Midwifery and Women’s Health, 55(1), 20–27. doi:10.1016/j.jmwh.2009.02.014.CrossRefPubMedGoogle Scholar
  20. Stafford, I., Dildy, G. A., Clark, S. L., Belfort, M. A., (2008). Visually estimated and calculated blood loss in vaginal and cesarean delivery. American Journal of Obstetrics and Gynecology, 199(5). doi:10.1016/j.ajog.2008.04.049.Google Scholar
  21. World Health Organization (WHO). Maternal, newborn, child and adolescent health. http://www.who.int/maternal_child_adolescent/topics/maternal/maternal_perinatal/en/. March 2014.

Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  • Lorine Wilcox
    • 1
  • Chethan Ramprasad
    • 2
  • Amanda Gutierrez
    • 2
  • Maria Oden
    • 3
  • Rebecca Richards-Kortum
    • 3
  • Haleh Sangi-Haghpeykar
    • 1
  • Manisha Gandhi
    • 1
  1. 1.Department of Obstetrics and GynecologyBaylor College of MedicineHoustonUSA
  2. 2.Rice UniversityHoustonUSA
  3. 3.Department of BioengineeringRice UniversityHoustonUSA

Personalised recommendations