Feasibility of a Quantification of Blood Loss Protocol for Vaginal Deliveries

Background: As standard practice, labor and delivery providers determine blood loss after a vaginal delivery via subjective visual estimation. This method is known to be inaccurate, which can delay the diagnosis and treatment of postpartum hemorrhage. To combat this, several patient safety and quality care groups have recommended the quantification of cumulative blood loss for every vaginal delivery as part of a comprehensive maternal hemorrhage protocol. University of North Carolina Hospitals in Chapel Hill, NC has discussed a pilot for a new quantification of blood loss (QBL) strategy as part of an updated obstetric hemorrhage protocol. At the time of this writing, they have yet to incorporate QBL into clinical practice in the labor and delivery unit. Objectives: To gather input from key stakeholders within the labor and delivery unit to determine the feasibility and likelihood of adopting a quantification of blood loss strategy as standard practice for vaginal deliveries at UNC Hospitals. Also, to identify the barriers of and facilitators to implementing such a protocol at UNC. Methods: I conducted 7 key stakeholder interviews with individuals who play key roles in the delivery of obstetric care at UNC Hospitals. Respondents included staff nurses, resident physicians, faculty/attending physicians, and health care leadership, all of whom contribute to clinical care in the labor and delivery unit. I then analyzed transcripts of each interview to find common themes within the participants’ answers.Findings: Five out of 6 (83.33%) stakeholders had negative views of visual estimation (VEBL) as standard practice for determining blood loss after a vaginal delivery. Only 2/7 (28.57%) believed that VEBL was sufficient for patient care. Not one stakeholder (0/7) thought VEBL was easy for providers. All providers (5/5) responding to a question about current QBL use reported infrequent quantification of blood loss in UNC’s labor and delivery. Some barriers to implementation of routine QBL reported by stakeholders included time and education of providers on new techniques. Four providers were knowledgeable about a proposed update to the UNC OB hemorrhage protocol that would include routine QBL as a new guideline. Conclusion: Leaders have convened an OB hemorrhage task force that is currently working to introduce an update to the UNC obstetric hemorrhage protocol. Changes to the clinical guidance include a strategy for QBL with routine use of calibrated collector bags and gravimetric measurement for high-risk blood loss. The stakeholder interviews show positive attitudes towards implementing change, so long as it is evidence-based and beneficial to the patients. Given buy-in from proper parties, a transition to routine QBL is likely feasible at UNC Hospitals’ labor and delivery unit.Master of Public Healt