Evaluation of measured postpartum blood loss after vaginal delivery using a collector bag in relation to postpartum hemorrhage management strategies: a prospective observational study

Christian Bamberg; Katja Niepraschk-von Dollen; Laura Mickley; Anne Henkelmann; Larry Hinkson; Lutz Kaufner; Christian von Heymann; Wolfgang Henrich; Franziska Pauly

doi:10.1515/jpm-2015-0200

Article

Evaluation of measured postpartum blood loss after vaginal delivery using a collector bag in relation to postpartum hemorrhage management strategies: a prospective observational study

Christian Bamberg , Katja Niepraschk-von Dollen , Laura Mickley , Anne Henkelmann , Larry Hinkson , Lutz Kaufner , Christian von Heymann , Wolfgang Henrich and Franziska Pauly

Published/Copyright: September 3, 2015

Published by

Become an author with De Gruyter Brill

Submit Manuscript Author Information Explore this Subject

From the journal Journal of Perinatal Medicine Volume 44 Issue 4

Abstract

Aim: To evaluate the incidence of postpartum hemorrhage (PPH) and severe PPH via routine use of a pelvic drape to objectively measure blood loss after vaginal delivery in connection with PPH management.

Methods: This prospective observational study was undertaken at the obstetrical department of the Charité University Hospital from December 2011 to May 2013 and evaluated an unselected cohort of planned vaginal deliveries (n=1019 live singletons at term). A calibrated collecting drape was used to meassure blood loss in the third stage of labor. PPH and severe PPH were defined as blood loss ≥500 mL and ≥1000 mL, respectively. Maternal hemoglobin content was evaluated at admission to delivery and at the first day after childbirth.

Results: During the study period, 809 vaginal deliveries were analysed. Direct measurement revealed a median blood loss of 250 mL. The incidences of PPH and severe PPH were 15% and 3%, respectively. Mean maternal hemoglobin content at admission was 11.9±1.1 g/dL, with a mean decrease of 1.0±1.1 g/dL. Blood loss measured after vaginal delivery correlated significantly with maternal hemoglobin decrease.

Conclusions: This study suggests that PPH incidence may be higher than indicated by population-based data. Underbuttocks drapes are simple, objective bedside tools to diagnose PPH. Blood loss should be quantified systematically if PPH is suspected.

Keywords: Collection drape; direct measurement; hemoglobin decline; postpartum blood loss; postpartum hemorrhage

Corresponding author: Christian Bamberg, MD, PhD, Klinik für Geburtsmedizin, Charité Universitätsmedizin, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353 Berlin, Germany, Tel.: +49-30-450664327, Fax: +49-30-450564901, E-mail: christian.bamberg@charite.de; and Department of Obstetrics, Charité - University Medicine Berlin, Germany

Acknowledgments

None of the authors have a conflict of interest. The author’s laboratory and study group received grants from CSL Behring.

References

[1] Kominiarek MA, Kilpatrick SJ. Postpartum hemorrhage: a recurring pregnancy complication. Semin Perinatol. 2007;31:159–66.10.1053/j.semperi.2007.03.001Search in Google Scholar

[2] Oyelese Y, Ananth CV. Postpartum hemorrhage: epidemiology, risk factors, and causes. Clin Obstet Gynecol. 2010;53:147–56.10.1097/GRF.0b013e3181cc406dSearch in Google Scholar

[3] Al Kadri HM, Al Anazi BK, Tamim HM. Visual estimation versus gravimetric measurement of postpartum blood loss: a prospective cohort study. Arch Gynecol Obstet. 2011;283:1207–13.10.1007/s00404-010-1522-1Search in Google Scholar

[4] Razvi K, Chua S, Arulkumaran S, Ratnam SS. A comparison between visual estimation and laboratory determination of blood loss during the third stage of labour. Aust N Z J Obstet Gynaecol. 1996;36:152–4.10.1111/j.1479-828X.1996.tb03273.xSearch in Google Scholar

[5] Berg CJ, Harper MA, Atkinson SM, Bell EA, Brown HL, Hage ML, et al. Preventability of pregnancy-related deaths: results of a state-wide review. Obstet Gynecol. 2005;106:1228–34.10.1097/01.AOG.0000187894.71913.e8Search in Google Scholar

[6] Bouvier-Colle MH, Ould El Joud D, Varnoux N, Goffinet F, Alexander S, Bayoumeu F, et al. Evaluation of the quality of care for severe obstetrical haemorrhage in three French regions. BJOG. 2001;108:898–903.Search in Google Scholar

[7] Patel A, Goudar SS, Geller SE, Kodkany BS, Edlavitch SA, Wagh K, et al. Drape estimation vs. visual assessment for estimating postpartum hemorrhage. Int J Gynaecol Obstet. 2006;93:220–4.10.1016/j.ijgo.2006.02.014Search in Google Scholar

[8] Prasertcharoensuk W, Swadpanich U, Lumbiganon P. Accuracy of the blood loss estimation in the third stage of labor. Int J Gynaecol Obstet. 2000;71:69–70.10.1016/S0020-7292(00)00294-0Search in Google Scholar

[9] Tixier H, Boucard C, Ferdynus C, Douvier S, Sagot P. Interest of using an underbuttocks drape with collection pouch for early diagnosis of postpartum hemorrhage. Arch Gynecol Obstet. 2011;283:25–9.10.1007/s00404-009-1265-zSearch in Google Scholar

[10] Tourne G, Collet F, Lasnier P, Seffert P. [Usefulness of a collecting bag for the diagnosis of post-partum hemorrhage]. J Gynecol Obstet Biol Reprod (Paris). 2004;33:229–34.10.1016/S0368-2315(04)96443-5Search in Google Scholar

[11] Zhang WH, Deneux-Tharaux C, Brocklehurst P, Juszczak E, Joslin M, Alexander S. Effect of a collector bag for measurement of postpartum blood loss after vaginal delivery: cluster randomised trial in 13 European countries. Br Med J. 2010;340:c293.10.1136/bmj.c293Search in Google Scholar PubMed PubMed Central

[12] World Health Organization. WHO recommendations for the prevention and treatment of postpartum haemorrhage. Geneva: WHO; 2012.Search in Google Scholar

[13] Schlembach D, PPH ID-A-C-K. Management der postpartalen Blutung Der D-A-Ch-Algorithmus. Frauenarzt. 2013;54.10.4414/smf.2013.01723Search in Google Scholar

[14] Biguzzi E, Franchi F, Ambrogi F, Ibrahim B, Bucciarelli P, Acaia B, et al. Risk factors for postpartum hemorrhage in a cohort of 6011 Italian women. Thromb Res. 2012;129:e1–7.10.1016/j.thromres.2011.09.010Search in Google Scholar

[15] Bais JM, Eskes M, Pel M, Bonsel GJ, Bleker OP. Postpartum haemorrhage in nulliparous women: incidence and risk factors in low and high risk women. A Dutch population-based cohort study on standard (> or = 500 ml) and severe (> or = 1000 ml) postpartum haemorrhage. Eur J Obstet Gynecol Reprod Biol. 2004;115:166–72.10.1016/S0301-2115(03)00639-0Search in Google Scholar

[16] Misme H, Dupont C, Cortet M, Rudigoz RC, Huissoud C. [Distribution of blood loss during vaginal delivery and cesarean section.]. J Gynecol Obstet Biol Reprod (Paris). 2015;pii S0368-2315(15)00031–9.Search in Google Scholar

[17] Bateman BT, Berman MF, Riley LE, Leffert LR. The epidemiology of postpartum hemorrhage in a large, nationwide sample of deliveries. Anesth Analg. 2010;110:1368–73.10.1213/ANE.0b013e3181d74898Search in Google Scholar PubMed

[18] Callaghan WM, Kuklina EV, Berg CJ. Trends in postpartum hemorrhage: United States, 1994-2006. Am J Obstet Gynecol. 2010;202:353 e1–6.10.1097/01.aoa.0000397145.24137.f5Search in Google Scholar

[19] Carroli G, Cuesta C, Abalos E, Gulmezoglu AM. Epidemiology of postpartum haemorrhage: a systematic review. Best Pract Res Clin Obstet Gynaecol. 2008;22:999–1012.10.1016/j.bpobgyn.2008.08.004Search in Google Scholar PubMed

[20] Gharoro EP, Enabudoso EJ. Relationship between visually estimated blood loss at delivery and postpartum change in haematocrit. J Obstet Gynaecol. 2009;29:517–20.10.1080/01443610903003159Search in Google Scholar PubMed

[21] Centre for Maternal and Child Enquiries. Saving mothers’ lives: reviewing maternal deaths to make motherhood safer: 2006-08. The eighth report on confidential enquiries into maternal deaths in the United Kingdom, 2011. Available at: https://www.cdph.ca.gov/data/statistics/Documents/MO-CAPAMR-CMACE-2006-08-BJOG-2011.pdf.Search in Google Scholar

[22] Bouwmeester FW, Bolte AC, van Geijn HP. Pharmacological and surgical therapy for primary postpartum hemorrhage. Curr Pharm Des. 2005;11:759–73.10.2174/1381612053381882Search in Google Scholar PubMed

[23] Upadhyay K, Scholefield H. Risk management and medicolegal issues related to postpartum haemorrhage. Best Pract Res Clin Obstet Gynaecol. 2008;22:1149–69.10.1016/j.bpobgyn.2008.08.007Search in Google Scholar PubMed

[24] Rath WH. Postpartum hemorrhage – update on problems of definitions and diagnosis. Acta Obstet Gynecol Scand. 2011;90:421–8.10.1111/j.1600-0412.2011.01107.xSearch in Google Scholar PubMed

[25] Rizvi F, Mackey R, Barrett T, McKenna P, Geary M. Successful reduction of massive postpartum haemorrhage by use of guidelines and staff education. BJOG. 2004;111: 495–8.10.1111/j.1471-0528.2004.00103.xSearch in Google Scholar PubMed

[26] Shields LE, Smalarz K, Reffigee L, Mugg S, Burdumy TJ, Propst M. Comprehensive maternal hemorrhage protocols improve patient safety and reduce utilization of blood products. Am J Obstet Gynecol. 2011;205:368 e1–8.10.1016/j.ajog.2011.06.084Search in Google Scholar PubMed

[27] Skupski DW, Lowenwirt IP, Weinbaum FI, Brodsky D, Danek M, Eglinton GS. Improving hospital systems for the care of women with major obstetric hemorrhage. Obstet Gynecol. 2006;107:977–83.10.1097/01.AOG.0000215561.68257.c5Search in Google Scholar PubMed

[28] Henrich W, Surbek D, Kainer F, Grottke O, Hopp H, Kiesewetter H, et al. Diagnosis and treatment of peripartum bleeding. J Perinat Med. 2008;36:467–78.10.1515/JPM.2008.093Search in Google Scholar PubMed

[29] Dahlke JD, Mendez-Figueroa H, Maggio L, Hauspurg AK, Sperling JD, Chauhan SP, et al. Prevention and management of postpartum hemorrhage: a comparison of 4 national guidelines. Am J Obstet Gynecol. 2015;213:76.e1–10.10.1016/j.ajog.2015.02.023Search in Google Scholar PubMed

The authors stated that there are no conflicts of interest regarding the publication of this article.

Received: 2015-6-18

Accepted: 2015-8-10

Published Online: 2015-9-3

Published in Print: 2016-5-1

You are currently not able to access this content.

Articles in the same Issue

https://doi.org/10.1515/jpm-2015-0200

Keywords for this article

Collection drape; direct measurement; hemoglobin decline; postpartum blood loss; postpartum hemorrhage