Investigating Maternal Blood Loss Measurement Methods and Risk Factors Associated with Postpartum Hemorrhages
Ben Travis ’22
Dr. James Greenberg, Dr. Logan Mauney, Dr. Thomas McEalth, Dr. Ronan Sugrue, Dr. Sarah Easter, Ayodele Lewis, Samantha Tola
James Greenberg, OB/GYN, Brigham and Women’s Hospital
Blood loss is a major source of severe maternal morbidity and mortality during childbirth. In this retrospective chart review, we examined 22,000 deliveries at a tertiary care center in Boston to investigate methods used to measure blood loss and define the factors that contribute to the risk of a postpartum hemorrhage. First, when comparing visually estimated blood loss records to more accurate, technologically quantified blood loss records, our results found that physicians overestimate blood loss of cesarean deliveries, and underestimate blood loss of vaginal deliveries to a statistically significant degree. We identified quantitative measurements as a better guide for determining when hemorrhage interventions are necessary, and strictly utilized blood loss records obtained with this methodology for subsequent investigations. Continuing to examine maternal blood loss in childbirth, we found that in a mother’s first childbirth, severity of laceration, birthweight, and length of 2nd and 3rd stages of labor are all associated with larger blood loss and likelihood of postpartum hemorrhage. Analysis of full-term vaginal deliveries showed that blood loss increased with each additional minute of the 3rd stage of labor, year of maternal age, and in vaginal births after prior cesarean section delivery, while women with previous vaginal births experienced less blood loss.