Related Experiment Video
Updated: Aug 18, 2025
Minimally Invasive Endoscopic Intracerebral Hemorrhage Evacuation
Published on: October 15, 2021
Clinical interventions are more accurate than quantitative measurements for defining hemorrhage with dilation and
Cassandra M Gilbert1, Melissa C Matulich2, Matthew D Ponzini3
1University of California, Davis School of Medicine, Sacramento, CA, United States.
Insights
Quantitative blood loss (QBL) during dilation and evacuation (D&E) procedures correlates with bleeding risks. Hemorrhage is best defined by clinical interventions, not just blood loss volume, in D&E cases.
Area of Science:
- Obstetrics and Gynecology
- Surgical Outcomes
- Patient Safety
Background:
- Dilation and Evacuation (D&E) is a common procedure.
- Assessing blood loss during D&E is crucial for patient safety.
- Defining hemorrhage thresholds for D&E procedures requires further investigation.
Purpose of the Study:
- To evaluate the correlation between quantitative blood loss (QBL) and clinically relevant outcomes or hemorrhage during D&E procedures.
- To determine if a specific blood loss volume can reliably predict adverse bleeding events.
- To refine the definition of hemorrhage in the context of D&E procedures.
Main Methods:
- Retrospective review of de-identified D&E procedures from a single institution.
- Surgeons recorded QBL during procedures and estimated blood loss post-procedure.
- Clinically relevant bleeding defined by interventions; hemorrhage defined by severe interventions within 24 hours.
Main Results:
- Clinically relevant bleeding occurred in 2%, 15%, and 58% of patients with blood loss <250mL, 250-500mL, and >500mL, respectively (p<0.0001).
- Hemorrhage rates were 0%, 4%, and 42% for the same blood loss categories (p<0.0001).
- 75% of patients with clinically relevant bleeding had QBL ≤500mL, with a median QBL of 312.5mL.
Conclusions:
- Higher quantitative blood loss (QBL) during D&E procedures is associated with increased risk of clinically relevant bleeding and hemorrhage.
- Defining hemorrhage based on necessary clinical interventions provides a more accurate assessment than relying solely on a specific blood loss volume.
- Clinical management of bleeding in D&E should focus on the need for interventions, not just quantified blood loss.
Objectives:
To assess if quantitative blood loss (QBL) with dilation and evacuation (D&E) procedures correlated with clinically relevant outcomes or hemorrhage.
Study Design:
We used a de-identified database to review D&E procedures performed at UC Davis Health from April 2019 through March 2020. Surgeons determined QBL during procedures and estimated blood loss, when excessive, during post-procedure recovery. We extracted patient demographic and procedure-related information. We defined clinically relevant bleeding as cases with bleeding-related interventions within 24 hours post-procedure including use of ≥2 uterotonics, tranexamic acid administration, cervical injury requiring repair, uterine balloon tamponade, blood transfusion, uterine artery embolization, hospitalization, or return to operating room; the latter 5 criteria defined hemorrhage. We used χ2 test for trend to evaluate bleeding outcomes.
Results:
We evaluated 431 procedures with a mean gestational age of 19 weeks and 3 days. Clinically relevant bleeding outcomes occurred in 6/319 (2%), 15/97 (15%) and 7/12 (58%) patients with total blood loss <250mL, 250-500mL and >500mL, respectively (p<0.0001); 11 had bleeding related to cervical injuries. Hemorrhage occurred in 0, 4/97 (4%) and 5/12 (42%) patients, respectively (p<0.0001). Patients with relevant bleeding outcomes had QBLs ranging from 150-1800mL (median QBL 312.5mL, interquartile range [IQR] 250-550mL) while those without clinically relevant bleeding ranged from 10-900mL (median QBL 150mL, IQR 75-200mL).
Conclusion:
Most patients (75%) with clinically relevant bleeding outcomes had QBL ≤500mL. Although higher QBL correlates with clinical interventions, the need for significant interventions rather than a single blood loss amount should be used to define hemorrhage with D&E procedures.
Implications:
Clinical hemorrhage is best defined by the necessary clinical interventions required to manage bleeding rather than any quantified amount of blood loss.
Related Concept Videos
01:28Esophageal Varices-II: Clinical Features and Management
In the initial assessment, a thorough review of the patient's medical history is vital to identify risk factors such as liver disease, alcohol...
01:20Venous Thrombosis II: Clinical Manifestations and Diagnostic Studies
01:26Endoscopic Studies II: Thoracocentesis
Description
Excess pleural fluid or air may accumulate in some respiratory disorders in the thoracic cavity. To treat pleural effusion, a physician conducts thoracentesis by carefully piercing the chest wall and entering...
01:26Varicose Veins II: Diagnostic Studies and Interprofessional Care
01:25Assessment of the Rectum and Anus
Rectal Inspection
Begin by inspecting the perianal and anal areas for color, texture, rashes,...