Hot Topic 3 Calculating Blood Loss at Delivery Catherine Angotti RN, MN, BScN Clinical Nurse Specialist, Labour and Delivery Mount Sinai Hospital Disclosures I have no disclosures, conflict of interests or affiliation with other
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Hot Topic #3 Calculating Blood Loss at Delivery
Catherine Angotti RN, MN, BScN
Clinical Nurse Specialist, Labour and Delivery
Mount Sinai Hospital<br>
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Disclosures I have no disclosures, conflict of interests or affiliation with other organizations to disclose.<br>
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Objectives Review practice changes from the SOGC Guideline for Postpartum Hemorrhage (2022)
Describe challenges with implementation
Explain concept of maximum allowable blood loss (MABL)
Describe semi-quantitative calculation of blood loss at delivery (SQBL)
Explain decision-making around when to transfuse patients<br>
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Introduction New SOGC Guidelines (12/2022) had many recommendations and practice changes that needed to be implemented to promote ongoing patient safety at MSH
PPH occurs 3.5 – 6% of each 100 births (SOGC, 2022).
MSH data collection reviewed shows PPH rate is 8 – 10% or closer to 700 PPH/year<br>
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Summary of Key Practice Changes Implemented<br>
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Challenges with Implementation Interdisciplinary team acceptance
OB, FP, Nursing, RM, Anesthesiology, Pharmacy, IT/documentation, policies and committees
Massive interdisciplinary education roll out
Multiple units (antenatal, L and D, postpartum) and team members
Approximately 110 staff RN’s, as well as MRP’s (RM, FP, OB, Anesthesia)
30 or more in-person 30-45 minute sessions
Equipment purchase, distribution and training
Weighing at all births and time of transfer (24 hours)
Semi-quantitative blood loss calculation which replaced visual estimates
Initial trials with staff before roll-out<br>
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Calculating Maximum Allowable Blood Loss<br>
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What to do with MABL? Consider clinical picture, vital signs, blood loss
Clinical scenario in conjunction with MABL, and communication with interdisciplinary teams will trigger need for blood transfusion<br>
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Calculating Blood Loss<br>
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PPH Cart<br>
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When to transfuse? Average answers from OB’s surveyed at MSH is:
Hbg 60-70 or when clinically indicated
MABL calculation
Always monitor the patient for subtle changes; weighing blood loss is not the priority in an emergency situation
Clinical patient presentation, prompt recognition, notification to OB/MFM, MRP, anesthesia, and interventions are most important<br>
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References California Maternity Quality Care Collaborative (2022). Obstetric Hemorrhage Toolkit, retrieved from: https://www.cmqcc.org/resources-tool-kits/toolkits/ob-hemorrhage-toolkit
Canadian Patient Safety Institute (CPSI) (2016). Hospital Harm Improvement Resource: Obstetric Hemorrhage, retrieved from https://www.patientsafetyinstitute.ca/en/toolsResources/Hospital-Harm-Measure/Documents/Resource-Library/HHIR%20Obstetric%20Hemorrage.pdf
The Society of Obstetricians and Gynaecologists of Canada (2022). SOCG Clinical Practice Guideline: Postpartum Hemorrhage and Hemorrhagic Shock. No. 431, December 2022 (Replaces No. 235, October 2009 & No. 115, June 2002)<br>
