Improving the accuracy of estimated blood loss at obstetric haemorrhage using clinical reconstructions



I wish to congratulate Dr Bose et al.1 for their study of estimating the volume of spilt blood and look forward to discussing the potential implementation of their findings with my obstetric colleagues.

As an anaesthetist, it is refreshing to have one’s natural tendency to compensate for surgical underestimations confirmed in print (I would suggest that the surgical-anaesthetic difference in estimations is even more marked when projecting the time to finish the surgery than it is for estimating blood loss). It has always struck me as absurd to try to put a figure to the volume of blood lost at delivery, for example caesarean section, since the actual figure recorded seems more related to predetermined triggers (e.g. 450 ml—or even on one occasion, 499 ml—rather than 500 ml, the latter being recorded according to protocols as a ‘postpartum haemorrhage’) and random numbers than to any attempt (or ability) to be accurate. From the point of view of dealing with the consequences of haemorrhage, I have always used my own categorisation of obstetric blood loss and tailored my management accordingly, and am happy to share it with your readership:

  • 1A little.
  • 2A lot.
  • 3Really a lot.