Visual estimation of blood loss at delivery is unreliable in a consistent direction: heavy losses are underestimated, often by half. That is why postpartum haemorrhage is so frequently recognised at the point of maternal collapse rather than at the point of bleeding.
Quantify instead. Weigh swabs, drapes and pads — one gram is one millilitre, and subtracting the dry weight takes seconds. Use a calibrated under-buttock drape for vaginal birth and measure suction volume separately from irrigation at caesarean. Record a running total rather than a single figure at the end, because the trajectory is what triggers escalation.
And read the physiology alongside the number. A young woman compensates until she does not: a normal blood pressure with a rising pulse and a narrowing pulse pressure in a woman who has just delivered is haemorrhage until proven otherwise. The shock index — heart rate divided by systolic pressure — above 0.9 is a better trigger than any single vital sign, and it costs nothing but arithmetic.
- Weigh swabs and drapes: one gram equals one millilitre, minus the dry weight
- Keep a running cumulative total, visible to the whole team, not a single end figure
- Measure suction separately from irrigation fluid at caesarean
- Use shock index above 0.9 as a trigger; young women compensate until late
- Treat a rising pulse with a normal blood pressure as bleeding until proven otherwise
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