How Accurate is Visual Estimation of Blood Loss During Vaginal Delivery? A Comparison with Calculated Blood Loss at Imo State University Teaching Hospital, Orlu, Imo State, Nigeria

Abstract

Postpartum haemorrhage (PPH) is one of the primary direct causes of maternal mortality and severe maternal morbidity globally. Traditionally, PPH has been defined as blood loss of ≥500 mL after vaginal delivery or ≥1,000 mL after caesarean delivery. However, recent definitions are more and more centred on blood loss in the setting of maternal haemodynamic impairment and clinical intervention. Estimating the amount of blood loss during delivery is critical for the early detection and treatment of PPH. Visual estimating is the most often employed method in many delivery units despite acknowledged issues about accuracy and the availability of numerous methods. This study evaluated the accuracy of visual estimated blood loss (VEBL) following vaginal delivery by comparing it with calculated estimated blood loss (CEBL) among women delivering at the Imo State University Teaching Hospital (IMSUTH), Orlu, Imo State, Nigeria. This was a comparative analytical study carried out among pregnant women who met the inclusion criteria and delivered vaginally at the labour ward of IMSUTH, Orlu. Participants were recruited during the study period and maternal height and weight were noted. PCV measures were taken before and after delivery. Maternal blood volume was assessed from maternal weight and height, and the computed blood loss was generated from the estimated maternal blood volume and the percentage change in pre- and postpartum PCV. The CEBL was compared with the VEBL observed by the visiting health care providers. Data was analysed using Statistical Package for the Social Sciences (SPSS) version 16.0. The mean blood loss with each approach was calculated and the sensitivity of VEBL and CEBL for diagnosis of primary PPH was found. 207 women delivered in the labour ward throughout the study period, 161 women met the eligibility criteria and were included in the analysis. Significant differences were noted between VEBL and CEBL, especially early in the research with significant over and underestimating of blood loss by visual evaluation. With increasing expertise and comparison with clinical and computed findings, visual estimation improved, and the difference between the two methods lessened as the trial progressed. There was statistically significant difference between VEBL and CEBL. In primary PPH detection, CEBL was more sensitive than VEBL. Visual assessment of blood loss after vaginal delivery is rather incorrect compared with computed blood loss and may lead to both overestimation and underestimation. This study exhibited increased sensitivity in the detection of primary PPH by calculated blood loss. Regular training, repeated assessment and the use of more objective methods of blood-loss monitoring may improve early detection of PPH and contribute to better maternal outcomes