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Tanzania Journal of Health Research
Health User's Trust Fund (HRUTF)
ISSN: 1821-6404
Vol. 14, No. 2, 2012, pp. 1-9
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Bioline Code: th12019
Full paper language: English
Document type: Research Article
Document available free of charge
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Tanzania Journal of Health Research, Vol. 14, No. 2, 2012, pp. 1-9
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Accuracy in diagnosis of postpartum haemorrhage using visual estimation of blood loss versus change in haematocrit in a tertiary teaching hospital in Tanzania
WANGWE, PETER J.T. & BALANDYA, BELINDA
Abstract
Postpartum haemorrhage is the leading cause of maternal death in the developing country and
yet is poorly diagnosed due to inaccurate measurement of blood loss following delivery. A study was
carried out at Muhimbili National Hospital (MNH) Tanzania between October 2005 and January 2006 to
determine the accuracy of visual estimation of blood loss (VEBL) in comparison to laboratory
measurement of blood loss in diagnosis of primary postpartum haemorrhage (PPH). A total of 426
pregnant women who were in active phase of labour were recruited and their venous blood was drawn
for estimation of haematocrit before delivery and 12 hours thereafter. Active management of third stage
of labour was conducted by giving 10IU of oxytocin (intramuscularly or intravenously) and this was
followed by visual estimation of blood loss. The proportion of patients who developed PPH was then
determined by both methods. The mean duration of third stage of labour was 8.3 minutes and mean
blood loss was 164.9ml. The prevalence of PPH was 8.9% and 16.2% by VEBL and changes in haematocrit,
respectively. Change in haematocrit in diagnosis of PPH was found to be more accurate, specific with
high positive predictive values compared to VEBL. The need for additional uterotonics was 5.8% and the
commonest labour complications associated with PPH were second degree tear, retained placenta and
EUA for continued bleeding. In conclusion, VEBL using calibrated vessel will increase accuracy where
conventional method using non calibrated method is used for diagnosis of PPH. Service providers
working in labour wards need to be trained on how to estimate blood loss using simulated methods so as
to increase their long term memory and accuracy in diagnosis of post-partum haemorrhage, hence
provision of immediate intervention.
Keywords
visual estimation; blood loss; postpartum; haemorrhage; haematocrit; Tanzania
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© Copyright 2012 - Tanzania Journal of Health Research
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