Thurer Robert L, Doctorvaladan Sahar, Carvalho Brendan, Jelks Andrea T
Medical Division, Gauss Surgical, Inc., Menlo Park, California.
Department of Obstetrics and Gynecology, Santa Clara Valley Medical Center, San Jose, California.
AJP Rep. 2022 Feb 4;12(1):e36-e40. doi: 10.1055/s-0041-1742267. eCollection 2022 Jan.
This study examined the accuracy, sources of error, and limitations of gravimetric quantification of blood loss (QBL) during cesarean delivery. Blood loss determined by assays of the hemoglobin content on surgical sponges and in suction canisters was compared with QBL in 50 parturients. QBL was moderately correlated to the actual blood loss ( = 0.564; < 0.001). Compared with the reference assay, QBL overestimated blood loss for 44 patients (88%). QBL deviated from the assayed blood loss by more than 250 mL in 34 patients (68%) and by more than 500 mL in 16 cases (32%). Assayed blood loss was more than 1,000 mL in four patients. For three of these patients, QBL was more than 1,000 mL (sensitivity = 75%). QBL was more than 1,000 mL in 12 patients. While three of these had an assayed blood loss of more than 1,000 mL, 9 of the 46 patients with blood losses of less than 1,000 mL by the assay (20%) were incorrectly identified as having postpartum hemorrhage by QBL (false positives). The specificity of quantitative QBL for detection of blood loss more than or equal to 1,000 mL was 80.4%. QBL was only moderately correlated with the reference assay. While overestimation was more common than underestimation, both occurred. Moreover, QBL was particularly inaccurate when substantial bleeding occurred. QBL is inaccurate in cesarean delivery.QBL deviated from the assay result by more than 500 mL in 32% of cases.QBL sensitivity and specificity for hemorrhage is 75.0% (95% confidence interval [CI]: 0.19-0.93) and 80.4% (95% CI: 0.69-0.92), respectively.
本研究探讨了剖宫产术中采用重量法对失血量（QBL）进行定量分析的准确性、误差来源及局限性。对50例产妇手术中使用的海绵和吸引器内的血红蛋白含量进行测定，以此确定失血量，并与QBL进行比较。QBL与实际失血量呈中度相关（r = 0.564；P < 0.001）。与参考测定相比，44例患者（88%）的QBL高估了失血量。34例患者（68%）的QBL与测定失血量的偏差超过250 mL，16例患者（32%）超过500 mL。4例患者的测定失血量超过1000 mL。其中3例患者的QBL超过1000 mL（灵敏度 = 75%）。12例患者的QBL超过1000 mL。虽然其中3例患者的测定失血量超过1000 mL，但在46例测定失血量小于1000 mL的患者中，有9例（20%）被QBL错误判定为产后出血（假阳性）。QBL检测失血量≥1000 mL的特异性为80.4%。QBL与参考测定仅呈中度相关。高估比低估更常见，但两者均有发生。此外，当大量出血时，QBL尤其不准确。剖宫产术中QBL不准确。32%的病例中，QBL与测定结果的偏差超过500 mL。QBL对出血的灵敏度和特异性分别为75.0%（95%置信区间[CI]：0.19 - 0.93）和80.4%（95%CI：0.69 - 0.92）。
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