Improved accuracy of postpartum blood loss estimation as assessed by simulation

Abstract

Objective. Caregivers underestimate the amount of blood loss, but this almost five decades-old assumption has not been validated. We aimed at assessing the accuracy of estimated blood loss by obstetrical teams during a simulated Postpartum hemorrhage (PPH) scenario. Study design. a prospective study conducted as part of the simulation-based training course, using sophisticated mannequin simulators adapted for obstetrical training by specially designed devices. Setting. Part of the simulation-based training course. Population. Obstetrical teams consisted of physicians and obstetrical nurses. Methods. Each of the participating obstetrical teams assessed blood loss during PPH scenarios. Their estimates were compared to the actual predefined 3.5-liter blood loss. An intervention group underwent a similar course in which they recorded their estimations after 1, 2 and 3.5 liters were lost. Outcome measures. Blood loss estimates after completion of the scenario in both groups. Results. Fifty obstetrical teams took part in the study. Eight comprised the interventional group. The average estimated blood loss was 1,780 ml (49% underestimation) for non-interventional teams. The interventional groups estimated blood loss to be 2,400 ml (32% underestimation). The main method of estimating blood loss was 'gut feeling', followed by verbalized guesses of team members and assessments of the 'patient's' hemodynamic status. Conclusions. Accuracy of blood loss estimations by a simulation-based PPH scenario was 50-60%. Measurements at predetermined intervals significantly improved accuracy of these estimations. Our study suggests that implementation of periodic estimations of blood loss in the management of PPH might improve clinical judgment. © 2008 Informa UK Ltd. (Informa Healthcare, Taylor & Francis AS).