Quantitative blood loss values reveal high rates of undiagnosed postpartum hemorrhage

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OBJECTIVE: In this study, we examined quantitative blood loss (QBL) values and postpartum hemorrhage (PPH) diagnoses in relation to clinical, demographic, and hospitalization related variables. METHODS: A retrospective chart review was conducted of deliveries at a regional hospital over a nine-month period, querying patient demographics, PPH diagnosis, blood loss, and hospital stay variables. RESULTS: PPH was substantially underdiagnosed by current USA guidelines (78%). Deliveries with >1000 mL of blood loss were not diagnosed with PPH (78%), including 84% of cesarean deliveries. Deliveries with >500 mL blood loss were not diagnosed with PPH (92%), including 89% of vaginal deliveries. There was no difference between estimated blood loss (EBL) and QBL levels for all deliveries (P = 0.9981); however, when separated by type of delivery, EBL was underestimated for vaginal deliveries (P = 0.02) and overestimated for cesarean deliveries (P = 0.02). PPH values were both associated with longer hospital stays (P < 0.001), and higher cost of care (P < 0.0001). Compared to Caucasian women, African American and Hispanic/Latina women had higher rates of PPH (P < 0.001 and P < 0.05, respectively). CONCLUSION: Quantitative measurement of blood loss identified many cases of undiagnosed PPH. Additionally, African American and Hispanic/Latina women were more likely to be diagnosed with PPH.

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