Diagnosing Postpartum Hemorrhage: A New Way to Assess Blood Loss in a Low-Resource Setting
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Diagnosing Postpartum Hemorrhage: A New Way to Assess Blood Loss in a Low-Resource Setting Lorine Wilcox1 • Chethan Ramprasad2 • Amanda Gutierrez2 • Maria Oden3 Rebecca Richards-Kortum3 • Haleh Sangi-Haghpeykar1 • Manisha Gandhi1
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Ó Springer Science+Business Media New York 2016
Abstract Introduction Postpartum hemorrhage (PPH) is the leading cause of maternal mortality worldwide. The largest barriers to treating PPH are symptom recognition and timely diagnosis. The SAPHE (Signaling a Postpartum Hemorrhage Emergency) Mat was constructed so that each square on the Mat absorbs up to 50 mL of blood. The objective of this study was to evaluate the correlation of visually estimated blood loss (EBL) using the SAPHE Mat with actual blood loss. Methods Thirty-six patients gave birth via vaginal delivery using the SAPHE Mat. Visual estimation of blood loss using the SAPHE Mat was calculated by multiplying the number of blood- saturated squares or partial squares by 50 mL. The visual EBL was compared with the actual blood loss calculated based on Mat weight before and after use (volume blood loss). Results Visual blood loss estimations were within 100 mL of the volume blood loss 69 % of the time and within 200 mL 97 % of the time. The mean difference between the visual EBL and volume blood loss (Mat weight change) was 80.91 mL. The Pearson correlation coefficient for visual EBL and volume blood loss was positive at 0.96 (p \ 0.001). Discussion The SAPHE Mat is able to provide a visual estimate of blood loss that is highly correlated with the actual blood loss on the mat. Future studies will assess
the ability to deploy the SAPHE Mat in low-resource settings as a potential guide for estimating blood loss to assist in improved management of PPH. Keywords Estimated blood loss Postpartum hemorrhage SAPHE Mat Vaginal delivery Low-resource setting
Significance We searched PubMed for articles published with the terms ‘‘maternal blood loss measurement’’, ‘‘blood loss AND pregnancy’’, ‘‘postpartum bleeding OR hemorrhage’’, ‘‘absorbent pad AND blood’’, ‘‘postpartum hemorrhage AND blood loss measurement.’’ From 248 publications, we identified 30 related to postpartum hemorrhage and measurement of blood loss. Our study demonstrates that visual estimation of blood loss using the SAPHE Mat is highly correlated with actual blood loss. The SAPHE Mat does not require formal medical knowledge or extensive training, making it suitable for low-resource settings. The SAPHE Mat has the potential to be used for blood loss measurement clinically.
Introduction & Lorine Wilcox [email protected] 1
Department of Obstetrics and Gynecology, Baylor College of Medicine, 6651 Main St, Ste 1096, Houston, TX 77030, USA
2
Rice University, 6100 Main Street, Houston, TX 77005, USA
3
Department of Bioengineering, Rice University, 6000 Main Street, Houston, TX 77005, USA
Postpartum hemorrhage (PPH), the leading cause of maternal death worldwide, occurs in nearly 14 million births and is responsible for approximately 140,000 maternal deaths e
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