Physiologic Labor

Students underestmate blood loss

Remember last week when I lamented that no one pays enough attention to communication skills? I’m excited to share this paper with you because it shows that at least someone is paying attention to the “hands on” skills acquisition. Unfortunately, the evidence from this study is that visually estimating blood loss isn’t very accurate.12  This is nothing really new and the reason many hospitals moved to the collection drape as a subjective measure of blood loss at delivery.

Many hospitals in the United States are moving to subjective measures of blood loss that involve weighing all materials during postpartum. This is probably a good move but not available everywhere in the world.  The good news is that practicing midwives were more accurate in their estimates than student midwives — so we know the skill improves with practice.  The bad news is that underestimation is a problem; especially in cases of severe postpartum hemorrhage.

Looking for ways to improve your estimation of blood loss?  I’ve added references to a few studies of methods to improve your skill.34

Pranal M, Guttmann A, Ouchchane L, et al. Do estimates of blood loss differ between student midwives and midwives? A multicenter cross-sectional study. M. 2018;59:17-22. doi:10.1016/j.midw.2017.12.017
Patel A, Goudar SS, Geller SE, et al. Drape estimation vs. visual assessment for estimating postpartum hemorrhage. I. 2006;93(3):220-224. doi:10.1016/j.ijgo.2006.02.014
Ali Algadiem E, Aleisa AA, Alsubaie HI, Buhlaiqah NR, Algadeeb JB, Alsneini HA. Blood Loss Estimation Using Gauze Visual Analogue. T. 2016;21(2). doi:10.5812/traumamon.34131
Merlin M, Alter S, Raffel B, Pryor P. External blood loss estimation using the MAR Method. Am J Emerg Med. 2009;27(9):1085-1090. [PubMed]
Jennifer (Author)