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A Comparison of Blood Loss Determination After Vaginal Delivery in El Salvador: Visual Estimation Versus Direct Measurement
Current Issue
Volume 4, 2017
Issue 6 (November)
Pages: 81-87   |   Vol. 4, No. 6, November 2017   |   Follow on         
Paper in PDF Downloads: 67   Since Oct. 18, 2017 Views: 1794   Since Oct. 18, 2017
Authors
[1]
Emi Sasagawa, Department of Midwifery and Women’s Health, School of Health Science & Nursing, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
[2]
Lizeth Elias de Buendia, Health Research and Investigation Unit, National Women's Hospital, San Salvador, El Salvador.
[3]
Guillermo Antonio Ortiz Avendano, Obstetric Department, National Women's Hospital, San Salvador, El Salvador.
[4]
Alba Marina Diaz de Navarro, Nursing Department, National Women's Hospital, San Salvador, El Salvador.
[5]
Hector Anibal Barrera Erazo, Nursing Department, National Women's Hospital, San Salvador, El Salvador.
[6]
Dalia Xochitl Sandoval Lopez, Health Research and Investigation Unit, National Women's Hospital, San Salvador, El Salvador.
[7]
Rafael Antonio Cedillos, Scientific Research Council, The University of El Salvador, San Salvador, El Salvador.
[8]
Kiyoshi Kita, School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan.
[9]
Chizuru Misago, Department of International and Cultural Studies, Tsuda College, Tokyo, Japan.
Abstract
Objective: This study aimed to compare the visual estimation and direct measurement methods for estimating blood loss in women following vaginal birth at a National Maternity Hospital in El Salvador. Study design: After delivery, attending physicians and nurses independently estimated the amount of postpartum blood loss by visual means and by direct measurement. Results: A total of 870 women underwent blood loss measurement. Visual estimation by physicians and nurses underestimated postpartum blood loss by 10.8% and 29.7%, respectively. When direct measurement of blood loss was regarded as the gold standard, visual estimation of blood loss by physicians had a sensitivity of 45.9% and a specificity of 91.1% for detecting postpartum hemorrhage (PPH). Visual estimation of blood loss by nurses had a sensitivity of 43.2% and a specificity of 94.4% for detecting PPH. Conclusions: In accordance with results from previous studies, healthcare providers tended to underestimate postpartum blood loss. The discrepancy between estimated and measured blood loss widened as blood loss volume increased. Given the low sensitivity of visual estimation in detecting PPH, this study revealed that more than half of PPH cases would not have been identified by visual estimation.
Keywords
Postpartum Hemorrhage, Visual Estimation, Direct Measurement, El Salvador
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