South African Journal of Obstetrics and Gynaecology

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Use of a visual aid to improve estimation of blood loss in obstetrics

N Makhubo, J.D. Makin, S Adam


Background. Postpartum haemorrhage (PPH) remains one of the most significant causes of maternal morbidity and mortality. In South Africa (SA) it is the second leading cause of maternal death. Educational programmes, such as visual aids, can improve the estimation of blood loss and subsequently improve clinical judgement and intervention.

Objective. To assess any improvement in blood loss estimation after the introduction of a visual aid.

Methods. We conducted an intervention study at the University of Pretoria Academic Complex and included the Departments of Obstetrics and Gynaecology and Anaesthesiology. The visual aid was created using surgical materials and expired blood from the SA National Blood Services. A pre-intervention objective structured clinical examination (OSCE) was conducted with various blood volumes. Thereafter, the visual aid was made available to all study participants. Nine months later, a second OSCE was conducted.

Results. Eighty-two participants were recruited and 21 were lost to follow-up. Sixty-one participants were included in the analysis. The overall score from the initial OSCE improved from 4.7500 to 5.6393 on the second OSCE (p=0.003). Participants tended to move from underestimation to either overestimation or accurate estimation of blood loss. The consultant group of participants were the most accurate in estimating blood loss (p=0.450).

Conclusion. The use of a visual aid can improve the estimation of blood loss by healthcare professionals, thus potentially improving resuscitation, and impacting positively on maternal morbidity and mortality associated with PPH, while improving the use of resources.
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