Determination of the volume of blood loss in prenatal and postnatal obstetric bleeding (clinical cases)

Abstract

Purpose - to analyze the amount of blood loss in prenatal and postpartum obstetric bleeding based on clinical cases. During the period from 2020 to 2022, on the basis of the Communal Enterprise «Regional Medical Center of Family Health» in Dnipro, an algorithm for quantitative determination of blood loss was implemented.

Clinical case 1. A 38-week pregnant woman was admitted with complaints of slight bleeding from the genital tract, which was not accompanied by pain. Diagnosis: «II pregnancy 38 weeks». The main presentation. Placenta previa (signs of placental abruption). Initially, blood smears up to 50.0 ml were determined. After 2 hours, blood loss was repeated and estimated at 250.0 ml (total blood loss 300.0 ml). Consilium decided to perform cesarean section (C-section). A girl was born, weighing 3450 g, with an Apgar score of 7/8. The total blood loss after KR was 850.0 ml.

Clinical case 2. The pregnant woman entered the hospital for delivery with a diagnosis: 3rd pregnancy of 36 weeks, placenta increta (invasion of the placenta into the muscular layer of the uterus), for C-section, During C-section, placental invasion through the uterine muscle layer into the bladder was diagnosed. The total blood loss after the operation was 5870.0 ml. The main complication in this case is usually a massive bleeding. To control the volume of blood loss, a protocol was used to quantify the amount of blood loss with the calculation of the rate of bleeding per minute, which helped both obstetricians to control the stages of surgical treatment and anesthesiologists to consider infusion-transfusion therapy in relation to the degree of blood loss.

Conclusions. In those cases when doctors control bleeding up to 250.0 ml, they use a visual method of assessing blood loss, more often this is the case with prenatal bleeding. In other cases, it is advisable to use a quantitative assessment of postpartum blood loss, this largely determined the timeliness of obstetric care, the implementation of balanced intensive infusion-transfusion therapy, the reduction of blood loss volumes, which led to the minimization of the use of donor blood preparations, and organ-preserving technologies were more often used in the provision of emergency care for obstetric bleeding.

The study was performed in accordance with the principles of the Declaration of Helsinki. Informed consent of women was obtained for the study.

No conflict of interests was declared by the author.