Figure 6 Number of cases detected for specific blood loss (p < 0.01). The calibrated drape more accurately determined true blood loss when > 250 ml and more accurately estimated overall levels efficiently as gold-standard spectrophotometry (Pearson's correlation coefficient of 0.928; p = 0.01, Table 3).
Use of the drape diagnosed postpartum hemorrhage four times as often as the visual estimate. A larger validation study is presently underway at the University of Missouri at Kansas City School of Medicine. In addition, the drape is being tested in a number of international settings including Tibet, Vietnam, Egypt, Ecuador, Brazil and Argentina. Based on the Indian experience, it appears to have great potential for training delivery attendants to determine postpartum blood loss in an accurate and timely manner. The drape, apart from being an objective tool for measurement of postpartum blood loss, also provided a hygienic delivery surface while permitting early management and referral. Residents and nurses in hospital settings and the nurse midwives who used the BRASSS-V drape during home delivery all found it to be a very useful tool to measure blood loss after delivery and for early diagnosis of postpartum hemorrhage; it also led to earlier transfer from rural areas to the higher facility. The women who delivered at home and their family members also appreciated the usefulness of the drape for easy disposal of body fluids after birth45.
A similar approach has been used in another recently reported study48. A plastic collecting bag put under the pelvis of the mother just after delivery can serve as a quantitative and objective method of measuring blood loss. The study goal was to assess sensitivity, specificity, positive predictive value and negative predictive value, including correlation between the bag's volume and hemoglobin and hematocrit variation. The authors conclude that the collecting pelvis bag is a rapid and precise procedure with which to diagnose postpartum hemorrhage in the delivery room. It also enables a visual and quantitative non-subjective estimation of blood loss. Because of its simplicity and very low cost, the pelvis collecting bag may have applicability as a routine preventive measure.
Accurate measurement of blood loss at delivery as a means of early detection of postpartum hemorrhage is necessary for several reasons, not the least of which is the fact that oxytocic agents, while an important component for addressing the third stage of labor, do not address many factors related to postpartum
Figure 7 Number of cases of postpartum hemorrhage (PPH) detected for specific blood loss (p < 0.01). The calibrated drape diagnosed PPH at a rate four times that of the visual estimate method
Figure 7 Number of cases of postpartum hemorrhage (PPH) detected for specific blood loss (p < 0.01). The calibrated drape diagnosed PPH at a rate four times that of the visual estimate method hemorrhage in resource-poor areas. Trauma of the birth canal during delivery and retained placental fragments are important causes of postpartum hemorrhage and may occur more often than previously reported. Visual assessment of blood loss in the presence of a contracted uterus may diagnose traumatic post-partum hemorrhage late and therefore result in delayed referrals. In India and many other developing nations, at least half of all births take place in rural areas. Most of these deliveries are conducted by indigenous health-care providers such as dais (traditional birth attendants) or auxiliary nurse midwives having varying levels of training. Blood loss appears to be commonly underestimated, as visual assessment is the only means available to the birth attendant to make this diagnosis. The clinical symptoms of blood loss (low blood pressure, fast pulse, pallor and sweating, signs of hypovolemia and impending shock) are often the primary indicators for intervention. However, relying on the onset of such symptoms may lead to delayed intervention, resulting in increased rates of morbidity and mortality. As other quantitative methods employed have both practical and technical limitations, the employment of simple tools, such as the BRASSS-V under-buttock blood collection drape with a calibrated receptacle, can be effectively employed for objectively assessing the blood loss. It is likely to be of great utility to the midwife/birth attendant and thus help to ensure more timely and accurate patient management. Having identified excessive blood loss, corrective measures can be taken at the earliest time, thus improving outcomes associated with postpartum hemorrhage.
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