Copyright © 2013, Program for Appropriate Technology in Health (PATH). All rights reserved.Cover photo credit: PATH/Amy MacIver.Funding for this technology assessment was provided by Merck.
<strong>Blood</strong> <strong>Loss</strong> <strong>Measurement</strong>SummaryDelayed diagnosis and poor management of postpartum hemorrhage (PPH) are associated with increasedmortality and morbidity. Accurate measurement of the amount of blood lost after childbirth helps toquickly diagnose life-threatening hemorrhage. Innovations in measuring blood loss could improve thetimely management of PPH.Statement of NeedObstetric hemorrhage is estimated to cause 25% of all maternal deaths and is the leading direct cause ofmaternal mortality worldwide. 1 Postpartum hemorrhage (PPH), defined as vaginal bleeding in excess of500 mL after delivery, is generally considered to account for a majority of the cases of obstetrichemorrhage, occurs in over 10% of all births, and is associated with a 1% case fatality rate. 2Although active management of the third stage of labor can prevent up to 60% of PPH cases, PPHcontinues to have a devastating impact on women in resource-poor settings where home births arecommon and hospitals or health facilities are often inaccessible. Obstetric hemorrhage accounts for 34% ofmaternal deaths in Africa, 31% in Asia, and 21% in Latin America and the Caribbean, while only 13% ofmaternal deaths in developed countries are due to hemorrhage. Women who survive PPH can suffer fromanemia postpartum. 3Most births and maternal deaths occur in Africa and Asia where home deliveries are common,infrastructure and transportation are limited, and birth attendants are scarce or inadequately prepared toprevent and treat PPH. 4 In such settings hemorrhage accounts for more than 30% of maternal deaths. 1 TheUnited Nation’s fifth Millennium Development Goal, to reduce 75% of maternal mortality by 2015,cannot be reached without addressing PPH. 5,6Several factors influence PPH rates, such as how blood loss is measured at delivery, how the third stage oflabor is managed (i.e., active management of the third stage of labor), or how obstetric interventions arecarried out (i.e., episiotomy). 7 Delayed diagnosis and poor management of PPH are associated withincreased maternal mortality and morbidity. Clinicians continue to rely on visual assessment to determinethe volume of postpartum blood loss even though studies have repeatedly shown visual estimates to beinaccurate (overestimating blood loss at low volumes and underestimating blood loss at high volumes).Technologies that can help women and clinicians estimate postpartum blood loss more accurately couldimprove management of PPH, reduce cases of severe PPH (blood loss greater than 1,000 mL), and reduce1
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