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The Alliance for Innovation on Maternal Health has developed an Obstetric Hemorrhage Patient Safety Bundle that is being increasingly adopted in hospitals within the United States 24 25 26 27 28. Recent efforts to decrease the incidence of maternal mortality and morbidity secondary to obstetric hemorrhage have focused on development of interdisciplinary team-based protocols that facilitate early diagnosis and treatment 24 25. However, other studies have not found that quantitative blood loss better predicts postpartum hemoglobin values 21 or changes the incidence of postpartum blood transfusion 22 23, and thus, the effect on clinical outcomes is less clear 20. Some studies found that the use of quantitative methods resulted in a higher likelihood that women who experienced a postpartum hemorrhage were identified 15 17 20. Quantitative methods of measuring obstetric blood loss have been shown to be more accurate than visual estimation in determining obstetric blood loss 14 15 16 17 18 19. Studies that have evaluated factors associated with identification and treatment of postpartum hemorrhage have found that imprecise health care provider estimation of actual blood loss during birth and the immediate postpartum period is a leading cause of delayed response to hemorrhage 10 11 12 13. Importantly, 54вЂ“93% of maternal deaths due to obstetric hemorrhage may be preventable 3 8 9 10. Hemorrhage that requires a blood transfusion is also the leading cause of significant maternal morbidity 4 5 6 7. Postpartum hemorrhage causes approximately 11% of maternal deaths in the United States and is the leading cause of death that occurs on the day of birth 2 3 4 5.

Obstetric hemorrhage is a major cause of maternal morbidity 1. However, further research is necessary to better evaluate the particular effect of quantitative blood loss measurement in reducing maternal hemorrhage-associated morbidity in the United States. Successful obstetric hemorrhage bundle implementation is associated with improved outcome measures related to obstetric hemorrhage. Interprofessional protocols for the assessment of blood loss, including quantitative assessment, for both vaginal and cesarean births are best developed by a multidisciplinary team. Implementation of quantitative assessment of blood loss includes the following two items: 1) use of direct measurement of obstetric blood loss (quantitative blood loss) and 2) protocols for collecting and reporting a cumulative record of blood loss postdelivery. Studies that have compared visual estimation to quantitative measurement have found that visual estimation is more likely to underestimate the actual blood loss when volumes are high and overestimate when volumes are low.ДЄlthough quantitative measurement is more accurate than visual estimation for identifying obstetric blood loss, the effectiveness of quantitative blood loss measurement on clinical outcomes has not been demonstrated. Quantitative methods of measuring obstetric blood loss have been shown to be more accurate than visual estimation in determining obstetric blood loss.

The American College of Obstetricians and Gynecologists makes the following recommendations and conclusions: However, further research is necessary to better evaluate the particular effect of quantitative blood loss measurement in reducing maternal hemorrhage- associated morbidity in the United States. Although current data do not support any one method of quantifying blood loss as superior to another, quantification of blood loss, such as using graduated drapes or weighing, provides a more accurate assessment of actual blood loss than visual estimation however, the effectiveness of quantitative blood loss measurement on clinical outcomes has not been demonstrated. Studies that have evaluated factors associated with identification and treatment of postpartum hemorrhage have found that imprecise health care provider estimation of actual blood loss during birth and the immediate postpartum period is a leading cause of delayed response to hemorrhage. Importantly, 54вЂ“93% of maternal deaths due to obstetric hemorrhage may be preventable. ABSTRACT: Postpartum hemorrhage causes approximately 11% of maternal deaths in the United States and is the leading cause of death that occurs on the day of birth.

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