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Major underestimation and overestimation of visual blood loss during cesarean deliveries: can they be predicted?

  • Maternal-Fetal Medicine
  • Published:
Archives of Gynecology and Obstetrics Aims and scope Submit manuscript

Abstract

Purpose

The surgeons’ visual estimation is the most widely used method for estimating blood loss (BL) while performing cesarean deliveries (CDs). Major BL underestimation may adversely influence obstetric decision making, and result in delaying interventions. Major BL overestimation may result in unnecessary costly interventions. Therefore, we aimed to identify independent predictors for major BL underestimation and overestimation during CDs.

Methods

All CDs performed between 11/2008 and 6/2016, in a university-affiliated hospital, were reviewed for demographic and surgical data, including the surgeons’ reported estimated BL (EBL). Calculated BL (CBL) was calculated by multiplying the calculated maternal blood volume by the percent of hematocrit decrease. Multivariate logistic regressions were performed to identify independent risk factors for major BL underestimation (CBL−EBL ≥ 400 ml) and overestimation (EBL−CBL ≥ 400 ml).

Results

During the study period, 3655 CDs were analyzed, of which 420 met the criterion for major BL underestimation and 1214 for major BL overestimation. Urgent surgery (aOR = 2.83; 95% CI 2.06–3.89), general anesthesia (aOR = 2.39; 95% CI 1.71–3.33), and higher surgeon experience (aOR = 1.03; 95% CI 1.01–1.06) were found to be independent risk factors for major BL underestimation, while any previous CD (aOR = 0.47; 95% CI 0.33–0.67) decreased the risk of underestimation. Any previous CD (aOR = 1.29; 95% CI 1.05–1.58) and intra-abdominal adhesions (aOR = 1.37; 95% CI 1.11–1.70) were found to be independent risk factors for major BL overestimation, while urgent CD (aOR = 0.50; 95% CI 0.41–0.60) decreased the risk of overestimation.

Conclusion

Various factors can predict major underestimation and overestimation of BL during CDs. Recognizing these factors can assist in the interpretation of visual EBL and improve obstetric decision making.

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Authors and Affiliations

  1. Department of Obstetrics and Gynecology, The Edith Wolfson Medical Center Holon, and Sackler School of Medicine, Tel Aviv University, P.O. Box 5, 58100, Holon, Israel

    Ohad Gluck, Yossi Mizrachi, Michal Kovo, Jacob Bar & Eran Weiner

  2. Department of Obstetrics and Gynecology, New York University School of Medicine, Lenox Hill Hospital, New York, NY, USA

    Michael Divon

Authors
  1. Ohad Gluck
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  2. Yossi Mizrachi
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  3. Michal Kovo
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  4. Michael Divon
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  5. Jacob Bar
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  6. Eran Weiner
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Contributions

OG: protocol development, data collection, data analysis, and manuscript writing. YM: data collection and data analysis. MK: protocol development, supervision, and data analysis. MD: protocol development, supervision, and manuscript writing. Jacob Bar: protocol development and supervision. EW: protocol development, data analysis, and manuscript writing.

Corresponding author

Correspondence to Eran Weiner.

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All authors have no conflicts of interest to report.

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Gluck, O., Mizrachi, Y., Kovo, M. et al. Major underestimation and overestimation of visual blood loss during cesarean deliveries: can they be predicted?. Arch Gynecol Obstet 296, 907–913 (2017). https://doi.org/10.1007/s00404-017-4506-6

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  • DOI: https://doi.org/10.1007/s00404-017-4506-6

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