Author(s): R. Ashwathkumar1
Leading causes of maternal mortality and morbidity in our country are postpartum haemorrhage and underlying anaemia. The current practice of assessing postpartum haemorrhage is by visual estimation by the birth attendant, which has subjective variation. Correlating the amount of blood lost as estimated by a standardised visual method with haemoglobin, haematocrit and other haematological parameters will help us to determine the utility of employing these measurements for assessing severity.
The aim of the study is to correlate the standardised visual estimate of blood loss with serial measurements of haemoglobin and haematocrit on the day of delivery and postpartum day 1 and 3.
MATERIALS AND METHODS
The present study is a cross-sectional study conducted at District Hospital, Belgaum, on 200 patients presenting to the hospital in latent labour. Outcome measures included measurement of haemoglobin, haematocrit before and after delivery, blood pressure and pulse rate before and after delivery. Measurement of blood loss by visual estimation; mean corpuscular volume, mean corpuscular haemoglobin concentration and red blood corpuscles count before and after delivery.
Three groups were made depending on the amount of blood lost. Comparison of mean haemoglobin, haematocrit and red blood corpuscles in each group showed that there was a direct proportion in reduction with the values from predelivery level to the amount of blood lost. In all 3 groups, significant correlation was seen between the mean blood loss estimated visually and reduction on day 1 day 3 against baseline values of haemoglobin, haematocrit and red blood corpuscles count.
The haematological and haemodynamic parameters used for the present study represents a simple procedure that can be easily employed to obtain objective and reliable assessment of blood lost in varying amounts. A fall in systolic blood pressure by 3.53% and 5.13% and diastolic blood pressure by 2.20% and 4.45% on first and third day may suggest postpartum haemorrhage.