Reliability of Visual Estimation of Intrapartum Blood Loss [10Q]

INTRODUCTION: Postpartum hemorrhage (PPH) remains a leading cause of maternal morbidity and mortality. Visual estimation of blood loss (VEBL) is commonly used to diagnose PPH, but its validity remains unknown. This study aimed to determine the accuracy of VEBL in diagnosing PPH. METHODS: Pregnant women over 18 years of age delivering vaginally or by caesarean delivery (CD) after 23 completed weeks of gestation were included. Blood loss was measured by weighing pre- and post-delivery sponges and linen (gravimetric method), and direct measurement of blood collected in the suction apparatus at CD. Obstetricians, nurses, and anesthesiologists involved in the delivery were asked to anonymously estimate blood loss. Their role in the delivery and years of experience were noted. Results were presented in numbers and proportions. RESULTS: Of 170 cases recruited, 157 were analyzed, including 123 CD and 34 vaginal deliveries. For CD, sensitivity of VEBL was 29.4% for primary surgeons, 16.7% for first assistants, 20% for anesthesiologists, 31.2% for scrub nurses, and 25% for circulating nurses. For vaginal deliveries, the sensitivity was 45.4% for primary obstetricians, and 37.5% for assistants. The specificity was between 89.5% and 100% for all participants with both CD and vaginal deliveries. Although sensitivity increased with years of experience, it remained low even for those with the greatest obstetric experience, at 40% for vaginal deliveries and 25.8% for CD. CONCLUSION: This study demonstrates low sensitivity of VEBL in diagnosing PPH. Methods that accurately and objectively quantify intrapartum blood loss are needed for clinical and research purposes.