Between 1993 to 2014, severe maternal morbidity increased by almost 200 percent in the United States.1 The rise in severe maternal morbidity is attributed mainly to an increase in red cell and component transfusion given in response to postpartum hemorrhage. Tragically, these medical incidents are frequently preventable.
Leading obstetrics organizations, such as ACOG, CMQCC, and SMFM, unilaterally recommend protocols that link hemorrhage management with cumulative blood loss measurement during vaginal or cesarean delivery.2,3 To follow these stage-based protocols, however, providers must access cumulative blood loss information in real time. This is a formidable challenge as most hospitals still either rely upon visual estimation of blood loss, which is notoriously inaccurate4, or use manual approaches to the quantification of blood loss (QBL). For example, a recent publication from the Association of Women’s Health, Obstetric and Neonatal Nurses (AWHONN) reported that gravimetric QBL compliance within 2 hours of delivery in New Jersey and Georgia is below 12%, due to several factors, including the associated workflow burden.5 QBL effectiveness is further complicated in the operating room due to the presence of non-sanguineous fluids.6 As argued in a recent AWHONN “Quantification of Blood Loss” Practice Brief, the lack of effective blood loss monitoring workflows is contributing to a national maternal health crisis.7
This month, the International Journal of Obstetric Anesthesia published a groundbreaking study of a system-wide attempt to modernize blood loss monitoring workflows and assess the clinical and financial impact of improved stage-based hemorrhage protocol compliance.8
Katz D, et al. researchers used Gauss Surgical’s TritonTM system to monitor blood loss in over 3800 vaginal and cesarean deliveries at Mount Sinai Hospital. Researchers compared these to a similar number of deliveries the prior year in which blood loss was assessed using visual estimation. Katz D, et al. subsequently determined that this comprehensive effort to monitor blood loss, supported by the Triton system as enabling technology, drove stage-based hemorrhage management compliance and produced earlier hemorrhage identification and intervention.