Bundle for quantifying vaginal blood loss after childbirth

This is a methodological study developed from February to August 2022, divided into bibliographic survey, instrument construction and content validity, by 14 experts. The instrument for validity consisted of 11 items selected from a systematic review. For each item in the bundle, a Likert scale was applied, and to check agreement among experts, the Concordance Index was calculated. Items with agreement above 80% were considered valid. Content validity was carried out in a single round of assessment.

Results

The final version of the bundle consisted of nine items. The proposed care is related to direct quantification of postpartum bleeding and its recording, observation of postpartum women, use of institutional protocols in cases of postpartum hemorrhage as well as team training.

Conclusion

The study allowed constructing and validating a bundle for quantifying vaginal blood loss after childbirth, with a view to improving postpartum hemorrhage diagnosis.

Postpartum hemorrhage; Blood loss, surgical; Postpartum period; Patient care bundles

Characteristics	n(%)
Sex
Female	13(92.9)
Male	1(7.1)
Degree
Postdoctoral	3(21.4)
PhD	8(57.2)
Master’s	3(21.4)
Activity
Teaching	12(85.8)
Care/management	2(14.2)
State of operation
São Paulo	5(35.8)
Rio de Janeiro	2(14.2)
Santa Catarina	2(14.2)
Federal District	2(14.2)
Minas Gerais	1(7.1)
Bahia	1(7.1)
Portugal	1(7.1)
Professors – institution
State	7(58.3)
Federal	5(41.7)
Variable (years)	Mean and standard deviation	Minimum and maximum
Age	49.2 ±13.5	30 – 76
Length of training	26.6 ± 13.8	7 - 54
Length of experience	20.6 ± 12.5	5 - 41
Criteria adapted from Fehring	15.2 ± 3.19	11 - 20

Item	Description	CI (%)
1	Conduct annual training using simulation for the entire obstetric team on quantifying postpartum blood loss	93
2	Institute a protocol for quantifying postpartum blood loss	93
3	Weigh all the drapes and compresses that will be used in the birth beforehand (Material Center)	86
4	Add weighted cards to the outer surface of birth packages	86
5	After removing postpartum women from the surgical table, weigh all fields in direct contact with her and soaked in blood on a calibrated scale	79
6	Weigh all items soaked in blood used at birth (compresses and gauze)	79
7	If clots come out, weigh them	86
8	At the end, subtract wet weight (drapes, compresses, gauze, clots) from dry weight (drapes weighed previously)	86
9	Record blood loss quantification	93
10	If postpartum hemorrhage is detected (loss of more than 500 ml), assess patients and initiate interventions, according to protocol	93
11	If available at the institution, carry out an assessment of hemoglobin and hematocrit levels upon admission (before birth) and 24 hours after birth	86

Item	Description
1	Conduct training at least annually, preferably every six months or when there are important changes in the team, using simulation, for the entire obstetric team on postpartum blood loss quantification
2	Institute a protocol for quantifying vaginal blood loss after childbirth
3	Weigh all drapes and compresses that will be used during birth in advance at the Material Center or during Surgical Center assembly, on a calibrated scale
4	Add weighted cards to the outer surface of birth packages
5	If clots come out, weigh them
6	At the end, subtract wet weight (drapes, compresses, gauze, clots) from dry weight (drapes weighed previously)
7	Record blood loss quantification
8	If postpartum hemorrhage is detected (loss of more than 500 ml), assess patients and initiate interventions, according to the institution’s PPH protocol
9	If available at the institution, carry out an assessment of hemoglobin and hematocrit levels upon admission (before birth) and 24 hours after birth

Escola Paulista de Enfermagem, Universidade Federal de São Paulo R. Napoleão de Barros, 754, 04024-002 São Paulo - SP/Brasil, Tel./Fax: (55 11) 5576 4430 - São Paulo - SP - Brazil
E-mail: actapaulista@unifesp.br

Acompanhe os números deste periódico no seu leitor de RSS

[1] Corresponding author: Mariana Torreglosa Ruiz E-mail: marianatorreglosa@hotmail.com