Quantifying Blood Loss in a Postpartum Hemorrhage- Placenta previa, abruption, and accreta -...
Transcript of Quantifying Blood Loss in a Postpartum Hemorrhage- Placenta previa, abruption, and accreta -...
Decisions/Results- “Measured blood loss by the
weighted blood loss (WBL) had
poor sensitivity for detection of
PPH compared to a reference
standard of a hemoglobin drop
>10%.”[2]
- “Underestimation was more
prominent in cases where more
than average-excessive blood
losses were simulated while
over estimations or accurate
estimations were more
prominent in less than average
blood loss incidents when using
WBL methods.”[1]
- Though quantitative changes in
hemoglobin pose more
accurate results, it is not an
optimal method of choice due to
its high cost.[2]
- WBL yields more accurate
results when done quickly to
reduce evaporation loss.[7]
- “The correlation coefficient
between measured blood loss
and corrected fall in hemoglobin
for all patients was 0.77;
correlation was stronger (0.80)
for postpartum hemorrhage
>1500mL.”[5]
Interventions- Ensure the stability of the patient
and make sure the uterus is firm,
bladder is empty, and no cervical
lacerations exist.[3]
- B-lynch suture can be used to
squeeze the uterus in order to stop
excessive bleeding. [3]
- Simple education programs for
assessing WBL can improve the
incidence of under-estimation when
assessing for PPH.[1]
- Evaluation of the cause of the PPH,
initiating oxytocin, draining the
bladder, fundal massage, and
administration of methylergonovine maleate. [3]
Quantifying Blood Loss in a
Postpartum HemorrhageJada LaFosse & April Troop
Faculty Mentor: Dr. Leslie Collins
Definitions- Postpartum hemorrhage (PPH):
historically defined as blood loss
>500cc for vaginal delivery and
>1,000cc for C-section delivery.
- Placenta previa: placenta is
attached to the uterine wall close to
or covering the cervix.
- Placental abruption: detachment of
the placenta before delivery.
- Accreta: placenta remains firmly
attached after delivery due to the
deep implantation of blood vessels
and placental tissues into the
uterus.
- Chorioamnionitis: inflammation of
fetal membranes due to infection.
PICOT QuestionIn a postpartum patient, does determining blood
loss via quantitative changes in hemoglobin
versus weighing postpartum pads yield more
accurate assessment information/diagnosis in a
postpartum hemorrhage?
Risk Factors- Placenta previa, abruption, and
accreta
- Multiple pregnancy (e.g., twins)
- Large for gestational age newborn
(more than 8.8 lbs)
- Failure to progress during the 2nd
stage of labor
- Instrumented delivery
- Maternal hypertensive disorder
(preeclampsia)
- Prior history of PPH
- Chorioamnionitis
- Prior C-section or uterine surgery
References
[1] Al-Kadri, H. M., Dahlawi, H., Airan, M. A., Elsherif, E., Tawfeeq, N., Mokhele, Y., . . . Tamim,
H. M. (2014). Effect of education and clinical assessment on the accuracy of postpartum
blood loss estimation. BMC Pregnancy and Childbirth, 14, 110. doi:10.1186/1471-2393-
14-110 (Hierarchy level 9)
[2] Atukunda, E. C., Mugyenyi, G. R., Obua, C., Atuhumuza, E. B., Musinguzi, N., Tornes, Y. F.,
. . . Siedner, M. J. (2016). Measuring Post-Partum Haemorrhage in Low-Resource
Settings: The Diagnostic Validity of Weighed Blood Loss versus Quantitative Changes in
Hemoglobin. Plos One, 11(4). doi:10.1371/journal.pone.0152408 (Hierarchy level 11)
[3] D'Alton, M. E., Cohen, J. S., Weinstein, D. L., & Dweck, M. F. (2014). Understanding Best
Practices in the Management and Treatment of Postpartum Hemorrhage. Contemporary
OB/GYN, 1-8. Retrieved October 25, 2017. (Hierarchy level 1)
[4] Humphrey, J. (15). Primary Cesarean Delivery Results in Emergency Hysterectomy due to
Placenta Accreta: A Case Study. AANA Journal , 83(1), 28-34. Retrieved October 26,
2017. (Hierarchy level 1)
[5] Lilley, G., Burkett-St-Laurent, D., Precious, E., Bruynseels, D., Kaye, A., Sanders, J., . . .
Collis, R. (2015). Measurement of blood loss during postpartum haemorrhage
[Abstract]. International Journal of Obstetric Anesthesia, 24(1), 8-14.
doi:10.1016/j.ijoa.2014.07.009 (Hierarchy level 7 )
[6] Rajput, V. (2013). Placenta Previa and its Management . Asian Journal of Nursing
Education & Research, 3(3), 134-135. Retrieved October 25, 2017. (Hierarchy level 1)
[7] Schorn, M. (2010). Measurement of Blood Loss: Review of the Literature. Journal of
Midwifery & Women's Health, 55(1), 20-27. Retrieved October 25, 2017, from
https://www.medscape.com/viewarticle/716622. (Hierarchy level 9)
(n.d.). Retrieved October 25, 2017, fromhttps://www.nature.com/articles/srep46333/figures/2