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Gravimetric blood loss measurement after delivery and during postpartum haemorrhage

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Gravimetric blood loss measurement after delivery and during postpartum haemorrhage (PPH). 

M John,  J Stevens,  K James,  P Collins,  S Bell,  R Collis,  C Bailey,  K Kelly,  T Kitchen,  T Edey,  E Macgillivray   OBS Cymru Team, Wales, UK

OBSCymru Quality Improvement Project: 

Aims to reduce severe morbidity from PPH in Wales.

Measurement of blood loss (MBL) is critical in early identification of abnormal bleeding.

MBL enables appropriate escalation of care. 

Introduction

Gravimetric MBL is more accurate than estimation.1
MBL needs to be integrated into a standardised care pathway.2
A national MBL training programme commenced in January 2017.
Site visits were performed to understand local barriers.
 

Methods

Continuous data is collected for all PPH (>1L) as part of a national database from January 2017 onwards.
Three prospective audit cycles conducted in all 12 Welsh Consultant-led Obstetric units have increased understanding regarding MBL practice.
All deliveries occurring in 1 week were included in each audit cycle. Data included mode and place of delivery, blood loss volume, type of collection equipment and whether loss was measured or estimated.
Analysis of correlation of drop in haemoglobin (Hb) vs MBL describes whether the intervention has been adopted as intended. Data was derived from the OBS Cymru database for a single unit.
 

Results

Continuous data and audit cycles are illustrated in Figures 1-3.
The analysis of correlation of drop in Hb vs MBL >1.5L revealed MBL accounted for 60% of the fall in Hb (adjusted for blood transfusion (Hb-10g/L per unit packed red cells)). 
 

Discussion

We demonstrate a sustained increase in MBL across all delivery types.
The focus is now on cumulative MBL to ensure timely escalation.
MBL accounted for 60% of the fall in Hb, indicating that even with the limitations of the current data there is value in adopting the intervention. This analysis is planned for all units.
Detailed audit results are fed back to all staff. Real-time data from the national database informs local improvements.
Site visits identified a lack of equipment (weighing scales, graded under-buttock conical drapes) as a barrier to MBL which has been addressed.
MBL is taught on the undergraduate midwifery curriculum and to all midwives and maternity care assistants on mandatory study days and during ad hoc sessions. MBL has been integrated into PPH training drills.
Staff have enthusiastically embraced this pillar of OBS Cymru.
 

References

1.Lilley G et al. Measurement of blood loss during postpartum haemorrhage.IJOA. 2015; 24(1): 8-14.

2.Hancock A, Wees AD, Lavender DT. Is accurate and reliable blood loss estimation the ‘crucial step’ in early detection of postpartum haemorrhage: an integrative review of the literature: BMC Pregnancy and Childbirth. 2015; 15: 230-238. 
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