Literature Review
Volume 6 Issue 11 - 2020
Comparison of Visual Estimation of Intraoperative Blood Loss with Haemoglobin Estimation in Patients Undergoing Caesarean Section at Term
Anya Sampson*, Onyekwulu Fidelis, Onuora Elias, Tonia Onyeka and Ajuzieogu Vincent
Department of Anaesthesia/Critical Care, East Sussex Health Trust, United Kingdom
*Corresponding Author: Anya Sampson, Department of Anaesthesia/Critical Care, East Sussex Health Trust, United Kingdom.
Received: October 29, 2020; Published: October 31, 2020


Background: Accurate assessment of intra-operative blood loss is an important aspect of peri-operative management of patients undergoing caesarean section and visual estimation is the most commonly used method and sometimes the only method available. Therefore, assessing the accuracy of visual estimation of blood loss compared to estimation using a point-of-care device such as the Hemocue is very relevant.

Aim and Objectives: This study compared intraoperative blood loss by visual estimation with blood loss calculated from haemoglobin (Hb) estimation using the HemoCue®201+ (AB Medical Inc Sweden).

Patients and Method: This was a prospective, double blind, non-randomized, controlled comparative study in which each patient acted as her own control. Sixty ASA physical status I or II pregnant patients at term undergoing elective caesarean section under spinal anaesthesia were enrolled into the study. In the theatre, the patients’ Hb level was determined using the Hemocue prior to preloading with 10 ml/kg of normal saline. Spinal anaesthesia was induced in the sitting position with 2.5 ml of 0.5% hyperbaric bupivacaine. Intraoperatively, standard monitoring (Heart Rate, Blood Pressure, Respiratory Rate, Electrocardiography, peripheral oxygen saturation and temperature) was observed and recorded for each patient. At the end of skin closure, the Hb level was measured using the HemoCue and blood loss was visually estimated and documented. A modified Gross formula was used to calculate the blood loss. Blood loss was visually estimated by the researcher (anaesthetist) and then compared with the measured blood loss using HemoCue.

Result: A total of sixty patients participated in this study. The mean visual estimated blood loss and HemoCue calculated blood loss were 470 ± 221 ml and 563 ± 204 ml respectively with p-value = 0.125 (paired t-test). There was a positive correlation between both methods (r = 0.66, n = 60, p = 0.002) using Pearson’s correlation. Agreement, according to Bland and Altman, indicated that the mean difference (bias) between both methods was +45 ml and discrepancy between the two methods widens when blood loss is more than 500 ml.

Conclusion: This study showed that visual estimation of intraoperative blood loss by the anesthetist did not differ significantly from Hemocue calculated blood loss during caesarean section. Visual estimation of blood loss by the anaesthetist is reliable and a useful skill especially in resource poor setting.

Keywords: Visual Estimation; Intraoperative Blood Loss; Haemoglobin Estimation; Caesarean Section


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Citation: Anya Sampson., et al. “Comparison of Visual Estimation of Intraoperative Blood Loss with Haemoglobin Estimation in Patients Undergoing Caesarean Section at Term”. EC Anaesthesia 6.11 (2020): 34-48.

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