Accuracy of visual estimation of blood loss in obstetrics using clinical reconstructions: an observational simulation cohort study.

Abstract

INTRODUCTION: Postpartum hemorrhage is the leading cause of maternal mortality worldwide, and optimal management requires accurate blood loss estimations. The aim of this study was to assess whether differences exist between visually estimated blood loss versus actual blood loss based on delivery mode, blood volume or distribution/location and knowledge of patient's current cardiovascular status.METHODS: For this observational cohort study, photographs were taken of 18 blood loss scenarios for vaginal delivery and cesarean delivery, and six photographs were duplicated and annotated with maternal vital signs. Scenarios were categorized into 50% (500?mL), 100% (1000?mL) and 200% (2000?mL) of the defined blood loss volume for postpartum hemorrhage and the photographs were shown to participants to visually estimate blood loss volumes.RESULTS: The mean?±?standard deviation estimates of actual 500?mL, 1000?mL and 2000?mL blood loss volumes were 1208?±?438?mL, 1676?±?630?mL and 2637?±?1123?mL, respectively (P?<0.001 among groups). The difference was significantly greater in vaginal delivery than cesarean delivery scenarios (1064?±?849?mL vs. 284?±?456?mL; P?<0.001). Estimated blood loss volume was not influenced by blood loss distribution/location, or by provider group or experience. The cardiovascular status of the patient impacted estimations only if tachycardia and hypotension were present.CONCLUSIONS: Most providers significantly overestimated blood loss volumes (by nearly 700?mL). Provider and scenario factors that impact inaccuracies in visual estimated blood loss identified in this study can be used to guide education and training.

View details for DOI 10.1016/j.ijoa.2022.103539

View details for PubMedID 35397264