University of California, San Francisco, Department of Obstetrics, Gynecology and Reproductive Sciences, 1001 Potrero Ave, 6D, San Francisco, CA 94110.
University of California, San Francisco, Department of Obstetrics, Gynecology and Reproductive Sciences, 1001 Potrero Ave, 6D, San Francisco, CA 94110.
Contraception. 2018 May;97(5):451-455. doi: 10.1016/j.contraception.2018.01.008. Epub 2018 Feb 2.
To compare estimated versus measured blood loss at the time of dilation and evacuation (D&E).
We measured blood loss for all D&E procedures between 16 and 24 weeks at one abortion clinic over 9 months. We weighed all blood-containing items and measured blood captured in the D&E tray. Providers recorded estimated blood loss before weighing or measuring blood. We compared median measured blood loss (MBL) and estimated blood loss (EBL) for each gestational week.
We measured blood loss in 371 of the 534 D&Es in the study period; we excluded 163 procedures because of failure to measure blood loss or contamination with amniotic fluid. Included and excluded procedures had similar median EBLs. Median EBL differed significantly from MBL for each week gestation from 16 to 24 weeks (p≤.001 for all comparisons); MBL was approximately twice as high as EBL for each gestational week. EBL and MBL increased with increasing gestation, as did the difference between EBL and MBL.
Providers consistently and significantly underestimate blood loss at the time of D&E. D&E providers may want to consider using a new heuristic for estimating blood loss.
Providers significantly underestimate blood loss at the time of D&E. Future research should confirm these findings (particularly at 22-24 weeks gestation), evaluate the efficacy of interventions to improve estimations of blood loss, and determine best practices for decreasing blood loss.
比较扩张和排空术（D&E）时的估计出血量与实际测量出血量。
在一家堕胎诊所，我们在 9 个月的时间内测量了所有 16 至 24 周妊娠的 D&E 手术中的出血量。我们对所有含有血液的物品进行称重，并测量 D&E 盘中采集到的血液。提供者在称重或测量血液之前记录估计出血量。我们比较了每个妊娠周的中位数实际测量出血量（MBL）和估计出血量（EBL）。
在研究期间，我们测量了 371 例 D&E 中的出血量；我们排除了 163 例因未能测量出血量或羊水污染而无法测量出血量的手术。纳入和排除的手术具有相似的中位数 EBL。从 16 周到 24 周，每个妊娠周的 EBL 中位数与 MBL 差异显著（所有比较的 p 值均≤.001）；MBL 每个妊娠周均高于 EBL。EBL 和 MBL 随妊娠增加而增加，EBL 和 MBL 之间的差异也随之增加。
提供者在 D&E 时始终低估出血量。D&E 提供者可能希望考虑使用新的启发式方法来估计出血量。
提供者在 D&E 时严重低估出血量。未来的研究应证实这些发现（尤其是在 22-24 周妊娠时），评估改善出血量估计的干预措施的效果，并确定减少出血量的最佳实践。
