A comparative study of Brass-V Drape and standardised visual estimation of blood loss during vaginal delivery – a single-observer study

Introduction
According to the World Health Organisation (WHO), postpartum haemorrhage (PPH) is a leading cause of maternal mortality, accounting for 35% of maternal deaths worldwide. If blood loss is not assessed correctly and managed swiftly, it may rapidly result in fatality. The accurate assessment of blood loss is a guide to treatment and helps identify the cause of excessive blood loss. The present study was aimed at improving the accuracy of blood loss estimation during vaginal delivery by standardising the visual estimation method using a pre-weighed gauge and mops. This was correlated with measurement using the sterile Brass-V Drape under the buttock to determine the volume of blood loss.

Material and methods
The study was conducted on 500 gravidas with singleton pregnancy undergoing vaginal delivery in the Labour room of Umaid hospital, Dr S.N. Medical College, Jodhpur (Rajasthan), to estimate and compare the accuracy of blood loss occurring during vaginal delivery using visual estimation (standardised) and Brass-V Drape method. The difference in estimation of blood loss by the two methods up to 100 ml was not considered significant in our study because this difference is unlikely to have any impact on maternal health.

Results
The mean blood loss in our study by standardised visual estimation method was 155.36 ±54.75 ml, and by Brass-V Drape estimation method it was 213.57 ±79.08 ml. The mean difference of blood loss in the two methods was 58.21 (213.57–155.36) ml. For vaginal blood loss up to 200 ml and up to 400 ml, the underestimation of blood loss by the standardised visual method was 41.9 ml and 99.34 ml, respectively. However, when the loss was more than 500 ml, the underestimation was 198 ml. Therefore, this trend is indicative of the fact that with the increase in blood loss, the inaccuracy of the standardised visual estimation also increases.

Conclusions
Although the Brass-V Drape estimation method is the gold standard, the standardised visual blood loss estimation method is more practical, economical, readily available, easy to understand, and can be implemented with just a minimum of training. It is definitely an appealing method of blood loss estimation for all healthcare providers at facilities dealing with childbirth. For normal vaginal deliveries, except for those with massive blood loss, standardised visual blood loss estimation should be recommended as a routine method even in remote and peripheral areas by almost all levels of health care providers.