Measured Blood Loss from More than 10,000 Vaginal Deliveries in Five Low Resource Countries: What Do the Numbers Tell Us about Postpartum Hemorrhage?

J. Blum, N.T.N. Ngoc, W. León V., E. Darwish, M. Cherine, B. Winikoff

Objective: A large multi-centre postpartum hemorrhage treatment trial enrolled over 10,000 women.  Blood loss after vaginal delivery was collected systematically using a calibrated bed sheet in an effort to quantify normal post-partum blood loss among women given oxytocin prophlatically during the third stage of labor and those given no prophylatic oxytocin.

Materials and Methods: Pre-delivery hemoglobin and blood loss following more than 10,000 vaginal deliveries has been recorded in five low resource countries. All providers were asked to indicate which of the components of active management of the third stage of labor were used at each delivery. Group A data includes hospitals where oxytonic is not used during the third stage of labor; Group B data includes hospitals where it is used systematically.

Results: Pre-delivery Hb was approximately 11.5, in both groups. Mean blood loss is approximately 415 mls and 255 mls for Groups A and B, respectively. PPH (> 500 mls blood loss) occurs for approximately 14% of women in Group A and 4% of women in Group B. Other components of AMTSL are used in 3 out of 10 deliveries in Group A and 9 out of 10 deliveries in Group B.

Conclusion: Active management of third stage of labor, including prophlatic use of oxytocin significantly reduces the incidence of PPH > 500 mls. Routine use of oxytocin is associated with greatly reduced risk of PPH and a lower mean blood loss. Data will be used to confirm, that even among women without PPH, oxtocin reduces blood loss during delivery.