[Anesthetic management of severe or worsening postpartum hemorrhage]

Visual estimation of postpartum blood loss during a simulation training: A prospective study

OBJECTIVE

The objective of our study was to compare visually estimated blood loss (with collector bags and absorbent pads) during postpartum with the real volume during a simulation training.

STUDY DESIGN

This study was conducted from May 23 to December 22, 2017 during training sessions on the theme of postpartum haemorrhage provided by the Elena perinatal network. 137 participants visually estimated the losses contained in 5 graduated collector bags (from 600 to 1800mL) and on 5 absorbent pads (from 200 to 1000mL).

RESULTS

The averages of the visual estimated blood loss were significantly different from the real value, except for absorbent pads containing 400mL of losses. The low volumes are better estimated for either the absorbent pads or collector bags (p<0.001). 57% of the volumes were underestimated with collector bags, 33% of the estimates were accurate to ± 50 mL. With absorbent pads, 51% of the estimates were underestimated, compared to 22%, that were accurate.

CONCLUSION

The simulation training allows to test the capacities of visual estimation of blood loss by health professionals in order to improve them and to improve the maternal care during postpartum haemorrhage.

Therapeutic and pharmaco-biological, dose-ranging multicentre trial to determine the optimal dose of TRAnexamic acid to reduce blood loss in haemorrhagic CESarean delivery (TRACES): study protocol for a randomised, double-blind, placebo-controlled trial

Background

Postpartum haemorrhage (PPH) is the leading cause of maternal death worldwide. Tranexamic acid (TA), an antifibrinolytic drug, reduces bleeding and transfusion need in major surgery and trauma. In ongoing PPH following vaginal delivery, a high dose of TA decreases PPH volume and duration, as well as maternal morbidity, while early fibrinolysis is inhibited. In a large international trial, a TA single dose reduced mortality due to bleeding but not the hysterectomy rate. TA therapeutic dosages vary from 2.5 to 100 mg/kg and seizures, visual disturbances and nausea are observed with the highest dosages. TA efficiency and optimal dosage in haemorrhagic caesarean section (CS) has not been yet determined. We hypothesise large variations in fibrinolytic activity during haemorrhagic caesarean section needing targeted TA doses for clinical and biological efficacy.

Methods/design

The current study proposal is a blinded, randomised controlled trial with the primary objective of determining superiority of either 1 g of TXA or 0.5 g of TXA, in comparison to placebo, in terms of 30% blood-loss reduction at 6 h after non-emergency haemorrhagic caesarean delivery (active PPH > 800 mL) and to correlate this clinical effect in a pharmacokinetics model with fibrinolysis inhibition measured by an innovative direct plasmin measurement regarding plasmatic TA concentration.

A sample size of 342 subjects (114 per group) was calculated, based on the expected difference of 30% reduction of blood loss between the placebo group and the low-dose group, out of which 144 patients will be included blindly in the pharmaco-biological substudy. A non-haemorrhagic reference group will include 48 patients in order to give a reference for peak plasmin level.

Discussion

TRACES trial is expected to give the first pharmacokinetics data to determinate the optimal dose of tranexamic acid to reduce blood loss and inhibit fibrinolysis in hemorrhagic cesarean section.

Trial registration

ClinicalTrials.gov, ID: NCT02797119. Registered on 13 June 2016.

Electronic supplementary material

The online version of this article (doi:10.1186/s13063-017-2420-7) contains supplementary material, which is available to authorized users.