Hamm Rebecca F, Wang Eileen, Romanos April, O'Rourke Kathleen, Srinivas Sindhu K
Department of Obstetrics and Gynecology, Maternal and Child Health Research Program, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania.
Am J Perinatol. 2018 Jan;35(2):134-139. doi: 10.1055/s-0037-1606275. Epub 2017 Aug 24.
The National Partnership for Maternal Safety released a postpartum hemorrhage bundle in 2015 recommending quantification of blood loss (QBL) for all deliveries. We sought to determine whether QBL more accurately predicts hemoglobin (Hb) drop than visually estimated blood loss (EBL).
This is a prospective observational study. Preintervention data (PRE) were collected on all deliveries between October 15, 2013 and December 15, 2013. Deliveries were included if EBL, admission Hb, and 12-hour postpartum Hb (12hrCBC) were available. QBL was implemented in July 2015. Postintervention data (POST) were collected between October 20, 2015 and December 20, 2015. A total of 500 mL EBL was predicted to result in 1 g/dL Hb drop at 12hrCBC. Student's -test was used to compare the means.
A total of 592 of 626 (95%) PRE and 583 of 613 (95%) POST deliveries were included. Overall, 278 (48%) POST deliveries had QBL recorded. In both PRE and POST, actual Hb drop differed from predicted by 0.6 g/dL in both groups of deliveries. When evaluating deliveries with EBL > 1,000 mL, QBL in POST was slightly better at predicting Hb drop versus EBL in PRE, although not statistically significant (0.2 vs. 0.5 g/dL, = 0.17).
In all deliveries, QBL does not predict Hb drop more accurately than EBL. The decision to perform QBL needs to balance accuracy with a resource intense measurement process.
国家孕产妇安全伙伴关系于2015年发布了产后出血综合措施，建议对所有分娩进行失血量量化（QBL）。我们试图确定QBL是否比目测估计失血量（EBL）更准确地预测血红蛋白（Hb）下降。
这是一项前瞻性观察性研究。收集了2013年10月15日至2013年12月15日期间所有分娩的干预前数据（PRE）。如果有EBL、入院时Hb和产后12小时Hb（12小时血常规）数据，则纳入分娩病例。QBL于2015年7月实施。收集了2015年10月20日至2015年12月20日期间的干预后数据（POST）。预计12小时血常规时总失血量500 mL会导致Hb下降1 g/dL。采用学生t检验比较均值。
626例（95%）PRE分娩中有592例、613例（95%）POST分娩中有583例被纳入研究。总体而言，278例（48%）POST分娩记录了QBL。在PRE和POST中，两组分娩的实际Hb下降与预测值均相差0.6 g/dL。当评估EBL＞1000 mL的分娩时，POST中的QBL在预测Hb下降方面比PRE中的EBL稍好，尽管差异无统计学意义（0.2 vs. 0.5 g/dL，P = 0.17）。
在所有分娩中，QBL预测Hb下降并不比EBL更准确。实施QBL的决定需要在准确性与资源密集的测量过程之间取得平衡。
