Abstract

RUBIO-ROMERO, Jorge Andrés; GUEVARA-CRUZ, Óscar A  and  GAITAN-DUARTE, Hernando. Validity of visual estimation of blood loss as diagnostic tool in severe post partum hemorrhage in an university hospital. Bogotá. 2007. rev.fac.med. [online]. 2010, vol.58, n.3, pp.173-184. ISSN 0120-0011.

Background. The difficulty to diagnose an abnormal hemorrhage of the post partum period is related to the need to wait until the presence of clinical signs of hypovolemia to confirm it. Objetive. To evaluate the diagnostic accuracy of visual estimation of blood quantity for the diagnosis of severe postpartum hemorrhage (SPPH) immediately after vaginal delivery. Material and methods. A diagnostic accuracy study was carried out in a cohort of pregnant women who had a vaginal delivery at an university hospital. It was approved by the ethics and investigation committees of participating institutions. A complex gold standard combining clinical and laboratory signs was defined: need of therapeutic maneuvers for treatment of post partum hemorrhage, drop of 10% or more of previous hematocrit or need of transfusion. Results. Incidence of SPPH was 10,7% of the 168 patients included. Median volume of estimated blood loss was 375 mL while median real observed blood volume was 475 mL. For the diagnosis of SPPH, estimated blood loss greater than 500 mL had a sensitivity and specificity of 77,8 y 73,3% respectively. For estimated blood loss greater than 800 mL, sensitivity and specificity were 44,4 and 94%. This cut point is the one that better classifies puerperal women requiring initial treatment for diagnose an abnormal hemorrhage of the post partum. Conclusions. Visual estimation of blood loss during delivery is a poorly sensitive and specific diagnostic test for the diagnosis of SPPH due to underestimation of the real magnitude of the blood loss occurred. Key words: validity of tests, reproducibility of results, sensitivity and specificity, postpartum hemorrhage. Rubio-Romero JA, Guevara-Cruz OA, Gaitán- Duarte H. Validity of visual estimation of blood loss as diagnostic tool in severe post partum hemorrhage in an university hospital. Bogotá. 2007. rev.fac.med. 2010; 58: 173-184.

Keywords : validez de las pruebas; reproducibilidad de resultados; sensibilidad y especificidad; hemorragia postparto.

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