Quantitative blood loss values reveal high rates of undiagnosed postpartum hemorrhage

Abstract

Objective

In this study, we examined quantitative blood loss (QBL) values and postpartum hemorrhage (PPH) diagnoses in relation to clinical, demographic, and hospitalization related variables.

Methods

A retrospective chart review was conducted of deliveries at a regional hospital over a nine-month period, querying patient demographics, PPH diagnosis, blood loss, and hospital stay variables.

Results

PPH was substantially underdiagnosed by current USA guidelines (78%). Deliveries with >1000 mL of blood loss were not diagnosed with PPH (78%), including 84% of cesarean deliveries. Deliveries with >500 mL blood loss were not diagnosed with PPH (92%), including 89% of vaginal deliveries. There was no difference between estimated blood loss (EBL) and QBL levels for all deliveries (P = 0.9981); however, when separated by type of delivery, EBL was underestimated for vaginal deliveries (P = 0.02) and overestimated for cesarean deliveries (P = 0.02). PPH values were both associated with longer hospital stays (P < 0.001), and higher cost of care (P < 0.0001). Compared to Caucasian women, African American and Hispanic/Latina women had higher rates of PPH (P < 0.001 and P < 0.05, respectively).

Conclusion

Quantitative measurement of blood loss identified many cases of undiagnosed PPH. Additionally, African American and Hispanic/Latina women were more likely to be diagnosed with PPH.