Visual estimation of blood loss at delivery is unreliable in a direction that matters - it under-reads the large bleeds and over-reads the small ones, so the woman who most needs escalation is the one whose loss is most likely to be recorded as normal.
Quantitative measurement needs no new equipment. Weigh the under-buttock drape and the swabs, subtract their dry weight, and read one gram as one millilitre. A calibrated drape does the same job with less arithmetic. The value of the number is not the number itself but that it is available early, while the response - uterine massage, a second uterotonic, tranexamic acid, calling for help - still has time to work.
The work only pays off if the measurement is embedded rather than optional: dry weights labelled on the pack, one person responsible for the running total, and the figure spoken aloud at 500 mL and again at 1,000 mL so that the whole room hears it.
- Label dry weights on drapes and swab packs so the subtraction is not done from memory
- Assign the tally to a named person at the start of every delivery, not when bleeding begins
- Announce the running total aloud at 500 mL and 1,000 mL
- Start the clock for tranexamic acid from the moment of diagnosis - the benefit falls with delay
- Audit recorded blood loss against transfusion rates; a mismatch means the measurement is not happening
Why it matters
Every uterotonic protocol below is judged against a blood loss figure, and most of those figures are guesses.
Read the rest in the app
You have read your two free briefings this month. The app carries all 27 specialties, every morning, free — and this finding is waiting in it.
Scan to keep reading on your phone. No account needed to start.
Tomorrow morning, before your first patient
One edition a day for obstetrics & gynaecology, written by the desk, every claim tied to its paper. Six minutes.
Get the app — free