Development and Assessment of Pictorial Guide for Improved Accuracy of Visual Blood Loss Estimation in Cesarean Delivery

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Estimated blood loss for surgical procedures performed via visual estimation is known to be an inaccurate method. Blood loss estimation is further complicated during cesarean delivery (CD) by a large volume loss for a short period as well as the presence of amniotic fluid. We hypothesized that a pictorial guide depicting premeasured blood volumes and materials commonly used in a CD would improve clinician accuracy in estimated blood loss.


A simulated CD scene was used to assess the ability of clinicians to estimate the amount of blood lost by a CD patient. Accuracy of the estimates was assessed before and after they had access to the pictorial guide created for the study.


Before the intervention, 52% of participants estimated more than 25% above or below actual blood loss volume. With use of the guide, clinicians became more accurate at blood loss estimation. After the intervention, the number of participants estimating within 5% of the actual volume increased from 7% before to 24% (P = 0.033).


An institution-specific pictorial guide is effective at improving the accuracy of visual blood loss estimation in a simulation and may help improve clinical care in CD.

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