Comparing visual estimation and hematocrit change in the assessment of blood loss among women undergoing cesarean delivery in a tertiary facility in northern Uganda.

IF 3.1 Q1 OBSTETRICS & GYNECOLOGY Therapeutic advances in reproductive health Pub Date : 2024-10-17 eCollection Date: 2024-01-01 DOI:10.1177/26334941241289552
Robert Edilu, Aaron Sanvu, James Ecuut, Alban Odong, Felix Bongomin, Ritah Nantale, Jackline Ayikoru, Baifa Arwinyo, Sande Ojara, Pebalo Francis Pebolo
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Abstract

Background: Cesarean section poses a fourfold risk for postpartum hemorrhage (PPH), necessitating accurate blood loss estimation to enable timely interventions. However, the conventional visual estimation method often leads to underestimation, resulting in undiagnosed PPH even in our setting, Uganda. Yet, the quantitative standard techniques remain underutilized.

Objective: We compared visual and calculated blood loss among women undergoing cesarean delivery at Gulu Regional Referral Hospital in northern Uganda.

Design: We employed a cross-sectional study design.

Methods: We enrolled pregnant women scheduled for cesarean section and determined both calculated and visually estimated blood loss. Data analysis involved using Pearson's moment correlation coefficient to compare the two methods and logistic regression to determine the factors associated with PPH.

Results: We included 105 participants, most were primigravida (n = 100, 43%), aged 15-24 years (n = 100, 52%), with term gestation (n = 100, 75%). The mean visual estimated blood loss (vEBL) was 235.3 ± 123.7 ml (interquartile range (IQR) 50-600 ml), while the calculated estimated blood loss (cEBL) was 435.0 ± 1328.2 ml (IQR -11,182.1-2226.7 ml). Visual estimation underestimated blood loss in 90% of cases (n = 100), and 21% (n = 21) had undiagnosed PPH (>1000 ml blood loss). None of the respondents had PPH (>1000 ml blood loss) following vEBL. There was a small positive correlation between both methods (vEBL and cEBL; r = 0.1165; p = 0.2482). Women aged >35 years were 1.60 times more likely to experience PPH than their counterparts aged 25-34 years (adjusted odds ratio (AOR): 1.60; 95% CI: 1.11-2.30, p < 0.011). Chorioamnionitis increased the risk of PPH by 2.2 times (AOR: 2.20; 95% CI: 1.20-4.05, p < 0.012).

Conclusion: The visual estimation technique significantly underestimated blood loss in up to 90% of cases, particularly during emergency cesarean sections. Among the 21% of cases diagnosed with PPH based on calculated blood loss, advanced maternal age and chorioamnionitis were notable contributing factors. Routine hemoglobin and hematocrit testing in obstetric care can be effectively utilized to objectively assess blood loss, aiding in the accurate diagnosis and management of PPH. Implementing these measures, even in resource-constrained settings, can significantly reduce the morbidity and mortality associated with PPH.

Trial registration: Not applicable.

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乌干达北部一家三级医院在评估剖宫产产妇失血量时,比较目测和血细胞比容变化。
背景:剖腹产导致产后出血(PPH)的风险高达四倍,因此必须准确估计失血量,以便及时采取干预措施。然而,传统的目测估算法往往会导致低估,从而导致即使在乌干达也无法诊断出 PPH。然而,定量标准技术仍未得到充分利用:我们比较了乌干达北部古卢地区转诊医院剖宫产产妇的目测失血量和计算失血量:设计:我们采用了横断面研究设计:我们招募了计划进行剖腹产的孕妇,并确定了计算失血量和目测失血量。数据分析包括使用皮尔逊矩相关系数对两种方法进行比较,以及使用逻辑回归法确定与 PPH 相关的因素:我们纳入了 105 名参与者,其中大多数为初产妇(100 人,占 43%),年龄在 15-24 岁之间(100 人,占 52%),妊娠足月(100 人,占 75%)。平均目测失血量(vEBL)为 235.3 ± 123.7 毫升(四分位距(IQR)50-600 毫升),而计算失血量(cEBL)为 435.0 ± 1328.2 毫升(IQR -11,182.1-2226.7 毫升)。90%的病例(n = 100)的目测估计值低估了失血量,21%的病例(n = 21)未确诊为 PPH(失血量大于 1000 毫升)。没有一名受访者在进行 vEBL 后出现 PPH(失血量大于 1000 毫升)。两种方法(vEBL 和 cEBL;r = 0.1165;p = 0.2482)之间存在微小的正相关性。年龄大于 35 岁的女性发生 PPH 的几率是 25-34 岁女性的 1.60 倍(调整后的几率比 (AOR):1.60;95% CI:1.11-2.30,p p 结论:在多达 90% 的病例中,目测估计技术严重低估了失血量,尤其是在紧急剖宫产手术中。在根据计算失血量确诊为 PPH 的 21% 病例中,高龄产妇和绒毛膜羊膜炎是显著的诱因。产科护理中的常规血红蛋白和血细胞比容检测可有效用于客观评估失血量,帮助准确诊断和处理 PPH。即使在资源有限的情况下,实施这些措施也能显著降低与 PPH 相关的发病率和死亡率:试验注册:不适用。
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