We'll get better at measuring things and I think that we'll be able to respond to changes better. I do think going forward, I definitely feel like even though it's uncomfortable learning this new thing, I feel like it makes sense. What Roxane was mentioning I find interesting is that there are so many things that we do where we're trying to be objective. Because when you're in a C-section, certainly, you're focused on the field and you're going to rely on your nurses to measure that. Now, it's really up to the nurses to help us out. With the new definitions of it being like 1,000 milliliters, whether it's a vaginal delivery or C-section. It's like 1 gram is equivalent to 1 milliliter. I think a lot of other societies and a lot of what are called perinatal quality collaboratives in each state that follow maternal mortality and follow metrics like these quality improvement metrics still use and are still pushing quantitative blood loss. I think even ACOG has changed a little bit on that where I don't think they're pushing, I think, quantitative blood loss. There's a lot of people that battle that back and forth. It's not an easy thing to do, but it's something that we've switched over because qualitative blood loss is probably not as accurate as quantitative blood loss. We also have to take into account amniotic fluid, which is also lost at the time of delivery. They have to know what it weighs prior to the delivery and what it weighs with blood. ![]() Our nurses now have to gather everything that has blood on it and they have to weigh it. Quantitative blood loss is a little bit more labor-intensive. We all learned what our 500 and what our 400 look like. I think we looked at the bag, we looked at the laps, and we looked at the blood all around, and we're like, "You know what? That's 500 ccs. You're right.īecause it was really easy to estimate blood loss. Gosh, quantitative blood loss, I think, is the bane of our practice at our university. Rampersad, you want to tell us what quantitative blood loss is? Now, there's been this movement where we have to do quantitative blood loss. I actually googled these pictures because I remember looking at a lap sponge and then having to make a guess on how much blood there is. When we do them, we used to qualitatively measure blood. Why I bring it up is, if you remember an interventional radiologist back when you were doing your clerkships through labor and delivery, the nature of deliveries, there is going to be blood loss at that time. When did you guys train? How far back are we talking? When we trained like when we talk about blood loss, if you remember. I feel like many of us get a chance to serve on those committees to interpret the evidence and make these protocols, but we really take them as guidance on what we do. One thing I want to point out for people that are listening that don't know, ACOG is the American College of Obstetricians and Gynecologists and they set our ground rules for what we do in practice. Greater than 500 and less than 1,000 is still an important number to pay attention to if someone has reached that state of blood loss after vaginal delivery. ![]() For vaginal delivery though, even though greater than 500 may not change your hemodynamic state, it's still an important number to look at for vaginal delivery. I think that's the number that we're paying attention to. Recently, ACOG has changed that definition to include blood loss greater than 1,000 ccs. Bleeding that occurs less than 24 hours after delivery is considered acute postpartum hemorrhage, while any bleeding from 24 hours to 12 weeks following delivery is considered late postpartum hemorrhage.Ĭan we talk about what is postpartum hemorrhage? Roxane, why don't we start with you? Then I'll let you guys kind of guide the conversation after we get some floor information established. The timing of the bleeding can clue the physician into the potential causes of the hemorrhage. Any material with blood on it is weighed and the measurements are recorded in order to calculate total blood loss. Today, many practices have switched to quantitative measurement as it is believed by many to be more accurate. In the past, most practices measured blood loss in a qualitative fashion they looked around at the blood all around the area during delivery and guessed roughly how much blood was lost. However, monitoring a patient’s hemodynamic state is important for blood loss between 5 ccs if patients deliver vaginally. Currently, ACOG defines postpartum hemorrhage as blood loss greater than 1000 ccs. While postpartum hemorrhage generally refers to excessive bleeding after childbirth, the specifics for diagnosis, set by the American College of Obstetricians and Gynecologists (ACOG), have changed over time.
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