Kahr Maike Katja, Brun Romana, Zimmermann Roland, Franke Denise, Haslinger Christian
Division of Obstetrics, University Hospital of Zürich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland.
Arch Gynecol Obstet. 2018 Dec;298(6):1071-1077. doi: 10.1007/s00404-018-4896-0. Epub 2018 Sep 17.
Reliable real-time estimation of blood loss is crucial for the prompt management of postpartum hemorrhage (PPH), which is one of the major obstetric complications worldwide. Our study aims at the validation of feasibility and precision of measured blood loss (MBL) with a quantitative real-time measurement system during (1) vaginal delivery and (2) cesarean section by comparison with a hemoglobin-based formula for blood loss as an objective control. This is the first study to include a reasonable number of patients in an everyday clinical setting.
921 patients were prospectively enrolled into this study (vaginal delivery: n = 461, cesarean delivery: n = 460) at a tertiary care hospital in Switzerland. Blood loss was measured by quantitative fluid collection bags. "Calculated blood loss" (CBL) was determined by modified Brecher`s formula based on the drop of hemoglobin after delivery. MBL based on our measurement system was compared to CBL by correlation analysis and stratified by the mode of delivery.
During vaginal delivery, MBL as determined by our quantitative measurement system highly correlated with CBL (p < 0.001, r = 0.683). This was also true for patients with cesarean deliveries (p < 0.001, r = 0.402), however, in a less linear amount. In women with cesarean deliveries, objectively low blood loss tended to be rather overestimated, while objectively high blood loss was more likely underestimated.
The technique of real-time measurement of postpartum blood loss after vaginal delivery as presented in this study is practicable, reliable and strongly correlated with the actual blood loss and, therefore, poses an actual improvement in the management of PPH.
可靠地实时估计失血量对于产后出血（PPH）的及时处理至关重要，产后出血是全球主要的产科并发症之一。我们的研究旨在通过与基于血红蛋白的失血量计算公式作为客观对照，验证定量实时测量系统在（1）阴道分娩和（2）剖宫产过程中测量失血量（MBL）的可行性和准确性。这是第一项在日常临床环境中纳入合理数量患者的研究。
在瑞士一家三级护理医院前瞻性招募了921名患者（阴道分娩：n = 461，剖宫产：n = 460）。通过定量液体收集袋测量失血量。“计算失血量”（CBL）通过基于产后血红蛋白下降的改良布雷彻公式确定。通过相关性分析将基于我们测量系统的MBL与CBL进行比较，并按分娩方式分层。
在阴道分娩期间，我们的定量测量系统确定的MBL与CBL高度相关（p < 0.001，r = 0.683）。剖宫产患者也是如此（p < 0.001，r = 0.402），然而，线性程度较低。在剖宫产的女性中，客观失血量低时往往被高估，而客观失血量高时更可能被低估。
本研究中提出的阴道分娩后产后失血量实时测量技术可行、可靠，与实际失血量密切相关，因此在产后出血管理方面有实际改进。
