Accurate Assessment of Blood Loss during Cesarean Delivery Improves Estimation of Postoperative Hemoglobin

Abstract

Objective To determine if accurate blood loss determination during cesarean delivery can improve the prediction of postoperative hemoglobin levels. Study Design This is a retrospective cohort study using visually estimated blood loss (traditional, n = 2,025) versus estimates using a mobile application that photographs sponges and canisters and calculates their hemoglobin content (device, n = 756). Results The correlation between the actual and predicted postoperative day 1 hemoglobin value (PPO1 Hgb) was better in the device group (R 2 = 0.519, correlation = 0.720) than in the traditional group (R 2 = 0.429, correlation = 0.655) (p = 0.005). For patients in the device group where the estimated blood loss was >1,000 mL (n = 53), the PPO1 Hgb was also better correlated with the actual value (R 2 = 0.319, correlation = 0.565) than the predictions using visually estimated blood loss for those patients in the device group whose visual estimation was >1,000 mL (n = 32) (R 2 = 0.035, correlation = 0.187) (p = 0.027). Conclusion Implementation of a device that accurately measures blood loss allows for a better prediction of postoperative day 1 hemoglobin concentration than is possible using visual blood loss estimation. This improvement was seen in the entire patient group and was particularly prominent in patients with blood losses of > 1,000 mL.