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Interest of using an underbuttocks drape with collection pouch for early diagnosis of postpartum hemorrhage
Hervé Tixier1, Carole Boucard, Cyril Ferdynus
1Service de Gynécologie-Obstétrique, Faculté de Médecine, Centre Hospitalier Universitaire de Dijon, 2 bd Maréchal de Lattre de Tassigny, Dijon Cedex, France. herve_tixier@yahoo.fr
Background:
Postpartum hemorrhage (PPH) is the principal cause of maternal death. Blood loss during delivery is often underestimated. The aim of this study was to evaluate the validity of using an underbuttocks collection pouch in the diagnosis of PPH.
Methods:
The study included a prospective series of 122 patients, over a period of 6 months, from May to October 2008. Variations in levels of hemoglobin and hematocrit during the 48 h following the childbirth confirmed the diagnosis of PPH. The graduated underbuttocks pouch allowed us to evaluate blood loss. The diagnostic value of the pouch was analyzed.
Results:
Mean age of the patients was 29.3 years. Mean pregnancy duration was 39.5 weeks of amenorrhea. Mean blood loss was 233.15 ml. Eighteen patients (14.7%) presented PPH and uterine arteries were embolized in two cases (1.6%). For a volume of 500 ml, the sensitivity of the pouch was 6.7%, and the specificity was 94.2%, The positive predictive value (PPV) was 66.7% and the negative predictive value (NPV) was 94.2%. For a threshold of 300 ml, sensitivity was 88.9%, specificity was 82.7%, the PPV was 47.0% and the NPV was 97.7%.
Conclusion:
The underbuttocks collection pouch is a simple, cheap and effective way to make an early objective diagnosis of PPH. It allows medical staff to implement appropriate therapy quickly thus avoiding risks due to delay. The diagnostic threshold to ensure optimal management remains to be determined.