• Siska Febrina Fauziah Postgraduate Applied Science Program in Midwifery, Poltekkes Kemenkes Semarang, Semarang, Indonesia,
  • Melyana Nurul Widyawati Postgraduate Applied Science Program in Midwifery, Poltekkes Kemenkes Semarang, Semarang, Indonesia,
  • Tecky Afifah Santy Amartha Postgraduate Applied Science Program in Midwifery, Poltekkes Kemenkes Semarang, Semarang, Indonesia,


Blood loss, postpartum hemorrhage, measurement


Backgrounds: Assessment of blood loss after delivery is important because intervention in the "golden hour” is crucial to prevent maternal morbidity and mortality. In fact, the biggest obstacle in overcoming postpartum blood loss are symptom recognition, accuracy, and timely diagnosis.

Aims: The objective of this study was to analyze the strengths and weaknesses between visual estimation and quantification of blood loss measurements.

Methods: Literature review was conducted using the electronic databases Science Direct, Pubmed, and Google Scholar. Measurement of blood loss and postpartum hemorrhage was used as keywords in searching strategy. A total of 23 from 17.200 of publications range from 2010 until May 2017 and presented in English language were included in this review.

Results: Many studies show that quantification of blood loss method is better than visual estimation. Visual estimation of blood loss was imprecise, tend to underestimate blood loss, and thus to delay diagnosis of PPH, whilst quantification of blood loss more accurate and objective. Nonetheless, quantification methods not used routinely due to their unavailability, more time consuming,
complicated, costly, and analyst workload increases.

Conclusions: Modified measurement method and its existing protocol needed to overcome blood loss during postpartum.


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World Health Organization. Maternal, newborn, child and adolescent health 2014. Available from:

Say L, Chou D, Gemmill A, Tunçalp Ö, Moller A-B, Daniels J, et al. Global causes of maternal death: a WHO systematic analysis. The Lancet Global Health. 2014;2(6):e323-e33.

Kementerian Kesehatan RI. Profil Kesehatan Indonesia Tahun 2015. Jakarta: Kementerian Kesehatan RI; 2016.

Trihono. Hasil Capaian Awal: Evidence Summit on Reducing Maternal and Neonatal Mortality in Indonesia 2016-

Jakarta: Akademi Ilmu Pengetahuan Indonesia; 2016.

Dinas Kesehatan Provinsi Jawa Tengah. Buku Saku Kesehatan Tahun 2016. Semarang: Dinas Kesehatan Provinsi Jawa

Tengah; 2016. p. 25-6.

Ika Fibriana A. Faktor-faktor risiko yang mempengaruhi kematian maternal (Studi kasus di Kabupaten Cilacap). Jurnal

Epidemiologi. 2007.

American Congress of Obstetricians and Gynecologysts. Obstetric Hemorrhage 2016. Available from:

Himpunan Kedokteran Feto Maternal. Pedoman Nasional Pelayanan Kedokteran: Perdarahan Pasca-Salin. Jakarta:

Perkumpulan Obstetri dan Ginekologi Indonesia; 2016.

World Health Organization. WHO recommendations for the prevention and treatment of postpartum haemorrhage:

World Health Organization; 2012.

Ganeshan M, Suharjono H. Management of Post Partum Haemorrhage. In: O&G Do, editor. Sarawak: Sarawak General

Hospital; 2012.

AWHONN. Quantification of Blood Loss: AWHONN Practice Brief Number 1. Journal of Obstetric, Gynecologic, &

Neonatal Nursing. 2015;44(1):158-60.

Schorn MN. Measurement of blood loss: review of the literature. Journal of midwifery & women's health.


Parayre I, Rivière O, Debost-Legrand A, LeÌmery D, Vendittelli F. Reliability of student midwives' visual estimate of

blood loss in the immediate postpartum period: A cross-sectional study. International journal of nursing studies.


Yoong W, Karavolos S, Damodaram M, Madgwick K, Milestone N, Al-Habib A, et al. Observer accuracy and

reproducibility of visual estimation of blood loss in obstetrics: how accurate and consistent are health-care

professionals? Archives of gynecology and obstetrics. 2010;281(2):207.

Lertbunnaphong T, Lapthanapat N, Leetheeragul J, Hakularb P, Ownon A. Postpartum blood loss: visual estimation

versus objective quantification with a novel birthing drape. Singapore Medical Journal. 2016;57(6):325.

Al Kadri HM, Al Anazi BK, Tamim HM. Visual estimation versus gravimetric measurement of postpartum blood loss:

a prospective cohort study. Archives of gynecology and obstetrics. 2011;283(6):1207-13.

Golmakani N, Khaleghinezhad K, Dadgar S, Hashempor M, Baharian N. Comparing the estimation of postpartum hemorrhage using the weighting method and National Guideline with the postpartum hemorrhage estimation by midwives. Iranian Journal of Nursing and Midwifery Research. 2015;20(4):471-5.

Withanathantrige M, Goonewardene M, Dandeniya R, Gunatilake P, Gamage S. Comparison of four methods of blood

loss estimation after cesarean delivery. International Journal of Gynecology & Obstetrics. 2016;135(1):51-5.

Ram GG, Suresh P, Vijayaraghavan PV. Surgeons often underestimate the amount of blood loss in replacement

surgeries. Chinese Journal of Traumatology. 2014;17(4):225-8.

Al-Kadri HM, Dahlawi H, Al Airan M, Elsherif E, Tawfeeq N, Mokhele Y, et al. Effect of education and clinical

assessment on the accuracy of post partum blood loss estimation. BMC pregnancy and childbirth. 2014;14(1):110.

Khadilkar SS, Sood A, Ahire P. Quantification of Peri-partum Blood Loss: Training Module and Clot Conversion

Factor. The Journal of Obstetrics and Gynecology of India. 2016;66(1):307-14.

Toledo P, McCarthy RJ, Burke CA, Goetz K, Wong CA, Grobman WA. The effect of live and web-based education

on the accuracy of blood-loss estimation in simulated obstetric scenarios. American journal of obstetrics and

gynecology. 2010;202(4):400. e1-. e5.

Zuckerwise LC, Pettker CM, Illuzzi J, Raab CR, Lipkind HS. Use of a novel visual aid to improve estimation of

obstetric blood loss. Obstetrics & Gynecology. 2014;123(5):982-6.

Toledo P, Eosakul ST, Goetz K, Wong CA, Grobman WA. Decay in blood loss estimation skills after web-based

didactic training. Simulation in Healthcare. 2012;7(1):18-21.

Wilcox L, Ramprasad C, Gutierrez A, Oden M, Richards-Kortum R, Sangi-Haghpeykar H, et al. Diagnosing

Postpartum Hemorrhage: A New Way to Assess Blood Loss in a Low-Resource Setting. Maternal and Child Health

Journal. 2016:1-8.

Sharareh B, Spencer Woolwine SS, Abraham P, Schwarzkopf R. Real time intraoperative monitoring of blood loss

with a novel tablet application. The open orthopaedics journal. 2015;9:422.

PATH. Blood Loss Measurement USA: PATH; 2013. Available from:

World Health Organization. Maternal Mortality 2016. Available from:

Vitello DJ, Ripper RM, Fettiplace MR, Weinberg GL, Vitello JM. Blood density is nearly equal to water density: a validation study of the gravimetric method of measuring intraoperative blood loss. Journal of veterinary medicine. 2015;2015.

Lilley G, Burkett-St-Laurent D, Precious E, Bruynseels D, Kaye A, Sanders J, et al. Measurement of blood loss during postpartum haemorrhage. International journal of obstetric anesthesia. 2015;24(1):8-14.

Atukunda EC, Mugyenyi GR, Obua C, Atuhumuza EB, Musinguzi N, Tornes YF, et al. Measuring Post-Partum Haemorrhage in Low-Resource Settings: The Diagnostic Validity of Weighed Blood Loss versus Quantitative Changes in Hemoglobin. PloS one. 2016;11(4):e0152408.

Dillard AC. Obstetric Hemorrhage in the Rural Emergency Department: Rapid Response. Journal of Emergency Nursing. 2017;43(1):15-20.

Gabel KT, Weeber TA. Measuring and communicating blood loss during obstetric hemorrhage. Journal of Obstetric, Gynecologic, & Neonatal Nursing. 2012;41(4):551-8.

Brooks M, Legendre G, Brun S, Bouet PE, Mendes LP, Merlot B, et al. Use of a Visual Aid in addition to a Collector Bag to Evaluate Postpartum Blood loss: A Prospective Simulation Study. Scientific Reports. 2017;7:46333.

Legendre G, Richard M, Brun S, Chancerel M, Matuszewski S, Sentilhes L. Evaluation by obstetric care providers of simulated postpartum blood loss using a collector bag: a French prospective study. The Journal of Maternal-Fetal & Neonatal Medicine. 2016;29(21):3575-81.

Tixier H, Boucard C, Ferdynus C, Douvier S, Sagot P. Interest of using an underbuttocks drape with collection pouch for early diagnosis of postpartum hemorrhage. Archives of gynecology and obstetrics. 2011;283(1):25-9.

Cortet M, Deneux-Tharaux C, Dupont C, Colin C, Rudigoz R-C, Bouvier-Colle M-H, et al. Association between fibrinogen level and severity of postpartum haemorrhage: secondary analysis of a prospective trial. British journal of anaesthesia. 2012;108(6):984-9.

Collins PW, Lilley G, Bruynseels D, Laurent DB-S, Cannings-John R, Precious E, et al. Fibrin-based clot formation as an early and rapid biomarker for progression of postpartum hemorrhage: a prospective study. Blood. 2014;124(11):1727-36.

De Lloyd L, Bovington R, Kaye A, Collis R, Rayment R, Sanders J, et al. Standard haemostatic tests following major obstetric haemorrhage. International journal of obstetric anesthesia. 2011;20(2):135-41.

Indrayan A. Clinical Agreement in Quantitative Measurements. In: Doi SAR, Williams GM, editors. Methods of Clinical Epidemiology. Berlin, Heidelberg: Springer Berlin Heidelberg; 2013. p. 17-27.

Shields LE, Smalarz K, Reffigee L, Mugg S, Burdumy TJ, Propst M. Comprehensive maternal hemorrhage protocols improve patient safety and reduce utilization of blood products. American journal of obstetrics and gynecology. 2011;205(4):368. e1-. e8.

Zhang W-H, Deneux-Tharaux C, Brocklehurst P, Juszczak E, Joslin M, Alexander S. Effect of a collector bag for measurement of postpartum blood loss after vaginal delivery: cluster randomised trial in 13 European countries. BMJ. 2010;340:c293.






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