QUANTITATIVE BLOOD LOSS

Evidence Based PracticeSusan Duthie MSN, RNC-OB, EFM

QUANTITATIVE BLOOD LOSS

Postpartum hemorrhage (PPH) is the leading cause of maternal morbidity & mortality.

PPH is cumulative blood loss greater than or equal to 1,000 ml, accompanied by signs of hypovolemia within 24 hours of birth, regardless of route of delivery.

Research has shown delays in early recognition & response contribute to poor maternal outcomes

QUANTITATIVE BLOOD LOSS

QBL is an objective method used to evaluate excessive bleeding.

Is evidence-based practice.

Leads to early recognition and prevention.

Our goal is to obtain QBL for all deliveries.

VISUAL ESTIMATION OF BLOOD LOSS

Visual estimation of blood loss continues to be used across the country.

Visual blood loss results in under and over estimation

Underestimation leads to delay in early life saving interventions.

Overestimation leads to costly and unnecessary interventions.

CALCULATION OF QBL VAGINAL DELIVERIES

Assess and record amount of fluid in under buttock drape prior to delivery of the placenta.

Subtract pre-placental fluid from total amount in drape at completion of delivery.

Weigh all bloody items minus dry weights (1 gram weight = 1 ml of blood volume).

QBL = (Volume in drape – pre-placenta volume) + (bloody items – dry weights).

CALCULATION OF QBLCESCAREAN SECTIONS

Switch suction canister following delivery of infant just prior to delivery of placenta.

Weigh all bloody laps, clots, linens, pads, and subtract dry weights along with any other bloody items.

QBL = Volume in 2nd canister + (bloody items – dry weights).

Change canister prior to delivery of placenta

Bloody laps – dry weights

QBL= Total Volume –pre-placenta fluid

Vag drape ______-_______ = __________ (total volume)-(Volume prior to delivery of placenta) + drape QBL

Laps _________-_________= __________(total weight) – (dry weight) = QBL

C-section 2nd canister – 1st canister –irrigation = QBL

RECOVERYTotal weight of bloody items – dry weights

DRY WEIGHTSLarge peri pad = 65 gSmall peri pad = 13gIce pack = 169 gBlue towel =60gLarge lap = 20gSmall lap = 6gWhite bed pads = 84gWash cloth = 20gMesh panties = 23 g

Bath towel = 215gFitted sheet = 400gC-section drape = 735gSmall trash bag = 14gLarge trash bag = 71gLap bag counter = 22gC-section bed drape = 292gGown regular = 355gGown large = 565gIce bag 3 g

SAFETY BUNDLEREADINESS Hemorrhage cart with supplies

Quick assess to medicationsResponse teamsUnit education & drills

RECOGNITION & PREVENTION Hemorrhage risk assessmentAccurate measurement of blood lossActive management of 3rd stage of labor

RESPONSE Hemorrhage plan with checklistSupport for families & staff

REPORTING/SYSTEMS LEARNING Huddles & debriefsMultidisciplinary reviewPerinatal quality improvement team

SUM IT ALL UPQBL LEADS TO EARLY RECOGNITION

SCENARIO #1G4 P1 39 weeks gestation presents in active labor & has a precipitous vaginal delivery. Please calculate QBL.

Drape prior to delivery of placenta 100cc’sDrape following completion of delivery 900cc’sSaline used to clean perineum 20 cc’s10 Small laps = 200g3 large peri pads in recovery weighing 350.Total QBL = _____________

CALCULATION FOR SCENARIO # 1

QBL = (total fluid – pre-placental fluid) + (weight of blood-soaked items – dry weights)

900 cc’s – 100 cc’s = 800 – 20 cc’s = 780 cc’c (drape)200 – (10 x 6) + 350 – (3 x 65) =

780 + 140 + 155 = 1,075 cc’cTOTAL QBL = 1,075

QBLREMEMBER TO COLLECT QBL DURING THE RECOVERY

PERIOD AND LONGER IF PATIENT CONTINUES TO HAVE EXCESSIVE BLOOD LOSS

ReferencesAmerican College Obstetricians & Gynecologists. (2019). ACOG Committee Opinion #794. Washington, D.C.

Association of Women’s Health, Obstetric & Neonatal Nurses. (2014). Quantification of Blood Loss: AWHONN Practice Brief Number 1. Journal of Obstetric, Gynecologic & Neonatal Nursing, 1-3.

Borovac-Pinheiro, A. et al. Postpartum hemorrhage: new insights for definition and diagnosis. American Journal of Obstetrics & Gynecology, August 2018, Volume 219, Issue 2, 162-168.

Thank you!

QUANTITATIVE BLOOD LOSSQUANTITATIVE BLOOD LOSSQUANTITATIVE BLOOD LOSSVISUAL ESTIMATION OF BLOOD LOSSCALCULATION OF QBL CALCULATION OF QBLChange canister prior to delivery of placentaBloody laps – dry weightsQBL= Total Volume – pre-placenta fluidSlide Number 11SAFETY BUNDLESUM IT ALL UPSCENARIO #1�CALCULATION FOR SCENARIO # 1QBLReferencesThank you!