Obstetrical blood loss by mode of delivery utilizing qualitative methods: Redefining normal

Objectives To measure ‘actual’ blood loss after childbirth through use of objective methods, including weighing of sponges, linens and use of clear calibrated delivery drapes. Methods All singleton vaginal deliveries and emergency cesarean deliveries occurring at a tertiary care centre between following initiation of a Post-Partum Hemorrhage Quality Improvement project between April-September 2019 were included for review. Elective cesarean deliveries were included following a delayed initiation of the project in the main surgical suites. Mean, median and range of blood loss were calculated. Results One thousand and fifty six deliveries met criteria for review; 716 vaginal deliveries, 258 emergency cesarean deliveries and 82 elective cesarean deliveries. For all vaginal deliveries, the mean, median and range of quantifiable blood loss for vaginal births was 557 mL, 400 mL and 100-5711 mL respectively, for emergency cesarean deliveries, 938 mL, 802 mL and 100–4188 mL and respectively and for elective cesarean deliveries was 730 mL, 678 mL and 50–2033 mL. Using current definitions of PPH \u003e500 mL for a vaginal delivery and \u003e1000 mL for a cesarean section, the associated rates of PPH for the various modes of deliveries was 39% (VD), 37% (ER CS) and 21% (ELCS) respectively. Conclusions Normative values for quantitative blood loss may be higher than previously appreciated visual estimated values. Care providers should be aware of this discrepancy as units adopt QBL as part of standard PPH management protocols.