TITLE:
Quantifying Maternal Blood Loss from the Hysterotomy at Cesarean Delivery
AUTHORS:
Rebecca M. Reimers, Daniela Carusi, Michaela K. Farber, James A. Greenberg
KEYWORDS:
Cesarean Section, Gravimetry, Blood Loss, Hysterotomy, Surgery, Humans, Obstetrics, Delivery
JOURNAL NAME:
Open Journal of Obstetrics and Gynecology,
Vol.10 No.8,
August
3,
2020
ABSTRACT: Background: With newer protocols, such as delayed cord clamping, becoming routine
practice, determining the potential maternal consequences is important. In
particular, establishing normative values for blood loss from the hysterotomy
would be helpful in addressing techniques to minimize total blood loss for
cesarean deliveries. Objective: Blood loss from the hysterotomy during
cesarean delivery has not been reported using quantitative methods. We aimed to
quantify the rate of blood loss during cesarean delivery from the hysterotomy
between creation and closure. Methods: This single center, prospective,
case series was collected in 2018. Women with singleton pregnancies undergoing
cesarean delivery at ≥37 0/7 weeks at Brigham and Women’s Hospital
were included. Delayed cord clamping was performed which allowed for
quantification of blood loss through gravimetric methods and descriptive
statistics were performed. Results: Twenty patients were included. The
mean hysterotomy closure delay for cord blood collection was 47 seconds (SD
10.2) and the mean maternal blood volume collected was 110.8 mL (SD 53.4 mL).
Blood loss per minute was calculated with a median of 150 mL/minute (IQR 88.8 mL, 95% CI 109.2 - 190.4 mL).
The mean post-operative hematocrit drop was 4.4%, and there were no
blood transfusions. There was a single hysterotomy extension and a quantified
blood loss of 413 mL per minute. Conclusion: We found a mean blood loss
of 150 mL/min without hysterotomy extension. With a hysterotomy extension, the
blood lost per minute was more profound. This normative data can be helpful for
surgical planning with regards to delayed cord clamping or cord blood
collection for banking.