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COMPARISON OF VISUAL ESTIMATION OF INTRAOPERATIVE BLOOD LOSS WITH HAEMOGLOBIN ESTIMATION IN PATIENTS UNDERGOING CAESAREAN SECTION AT TERM.
ABSTRACT
Background
Accurate assessment of intra-operative blood loss is an important aspect of peri-operative
management of patients undergoing caesarean section and visual estimation is the most
commonly used method and sometimes the only method available. Therefore, assessing the
accuracy of visual estimation of blood loss compared to estimation using a point-of-care device
such as the HemoCue is very relevant.
Aim and Objectives;
This study compared intraoperative blood loss by visual estimation with blood loss calculated
from haemoglobin (Hb) estimation using the HemoCue®201+ (AB Medical Inc Sweden).
Patients and Method;
This was a prospective, double blind, non randomized, controlled comparative study in which
each patient acted as her own control. Sixty ASA physical status I or II pregnant patients at term
undergoing elective caesarean section under spinal anaesthesia were enrolled into the study. In
the theatre, the patients’ Hb level was determined using the Hemocue prior to preloading with
10ml/kg of normal saline. Spinal anaesthesia was induced in the sitting position with 2.5ml of
0.5% hyperbaric bupivacaine. Intraoperatively, standard monitoring (Heart Rate, Blood Pressure,
Respiratory Rate, Electrocardiograpghy, peripheral oxygen saturation and temperature) was
observed and recorded for each patient. At the end of skin closure, the Hb level was measured
using the HemoCue and blood loss was visually estimated and documented. A modified Gross
formula was used to calculate the blood loss. Blood loss was visually estimated by the researcher
(anaesthetist) and then compared with the measured blood loss using HemoCue.
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Result;
A total of sixty patients participated in this study. The mean visual estimated blood loss and
HemoCue calculated blood loss were 470 ± 221ml and 563 ± 204ml respectively with p-value
=0.125 (paired t-test). There was a positive correlation between both methods (r = 0.66, n = 60, p
= 0.002) using Pearson’s correlation. Agreement, according to Bland and Altman, indicated that
the mean difference (bias) between both methods was +45ml and discrepancy between the two
methods widens when blood loss is more than 500ml.
Conclusion;
This study showed that visual estimation of intraoperative blood loss by the anaesthetist did not
differ significantly from Hemocue calculated blood loss during caesarean section. Visual
estimation of blood loss by the anaesthetist is reliable and a useful skill especially in resource
poor setting
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