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Expedite assessment of postpartum blood loss.(Obstetrics)
KAILUA KONA, HAWAII -- By the time you detect changes in maternal blood pressure or heart rate suggesting postpartum hemorrhage, the woman already has lost a third of her blood volume, Dr. George R. Saade said at a conference on obstetrics, gynecology, perinatal medicine, neonatology, and the law.
"Do not wait to start seeing signs and symptoms. As soon as you start estimating that the patient is losing a lot of blood, you have to start acting right then and there," said Dr. Saade, professor of obstetrics and gynecology at the University of Texas Medical Branch, Galveston.
Orthostatic hypotension would tell you that the patient has lost 20%-25% of her blood, but if she is sitting or lying down on the delivery table, you're unlikely to detect that symptom. Hypotension reflects a loss of 30%-35% of blood volume. "Do not wait for hypotension" to treat for postpartum hemorrhage, he said at the meeting sponsored by Boston University. Clinicians typically underestimate postpartum blood loss by 30%-50%, studies suggest. On average, women lose about 500 cc in a vaginal delivery, 1,000 cc in a cesarean section, and 1,500 cc in a cesarean hysterectomy.
Dr. Garry Feinstadt, a general practitioner in Vancouver, B.C., said during a question-and-answer session that his work on quality assurance committees has convinced him that clinicians commonly record blood loss using inaccurately low numbers. "How can we teach people to accurately and honestly record blood loss?" he asked.
Dr. Saade suggested instituting a system of weighing uterine packs and learning how weights correlate with blood loss, then following a protocol of actions triggered by the weights.
Dr. Michael A. Belfort commented that his institution, St. Mark's Hospital in Salt Lake City, recently initiated a program to train nurses to estimate blood loss based on work done by Dr. Gary A. Dildy III, also of the hospital. A standard operating lap sponge soaked in blood, for example, will contain about ...
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Source: HighBeam Research, Expedite assessment of postpartum blood loss.(Obstetrics)