Quantification of Blood Loss: AWHONN Practice Brief Number 13
Open accessIntegrity signals
Registry
Cites
Statistics
Claims the paper makes
2 of 44 cited sources checked · 2 supported · 0 flagged
- Premisecitation
In studies comparing visual EBL to colorimetric image analysis during cesarean birth, visual EBL was reported to overestimate blood loss.
“In studies to compare visual EBL to colorimetric image analysis during cesarean birth, researchers reported overestimation with the use of visual EBL (Doctorvaladan et al., 2017;Hire et al., 2020).”
Quote in the paperSubstantial claim1 of 2 sources checked - Premisecitation
Visual estimation of blood loss has long been established as an inaccurate measure that can potentially lead to delays in timely recognition and response to obstetric hemorrhage.
“Visual estimation of blood loss (EBL) has long been established as an inaccurate measure that can potentially lead to delays in timely recognition and response to obstetric hemorrhage (Al Kadri et al., 2011;Brant, 1967).”
Quote in the paperSubstantial claim1 of 2 sources checked - Premisecitation
Quantification of blood loss has been shown to be more accurate than visual EBL.
“Quantification of blood loss has been shown to be more accurate than visual EBL (ACOG, 2019;Powell et al., 2020).”
Quote in the paperSubstantial claim0 of 2 sources checked- cites ACOG, 2019
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- cites Powell et al., 2020
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- Premisecitation
Visual estimation increases the likelihood to overestimate blood loss when volumes are low.
“Visual estimation increases the likelihood to underestimate blood loss when volumes are high and to overestimate blood loss when volumes are low (ACOG, 2019).”
Quote in the paperSubstantial claim0 of 1 sources checked- cites ACOG, 2019
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- Premisecitation
Analyses of root causes in maternal mortality reviews have consistently identified missed or delayed diagnosis and delays in initiating treatment when EBL was used.
“Analyses of root causes in maternal mortality reviews have consistently identified missed or delayed diagnosis and delays in initiating treatment when EBL was used (ACOG, 2019).”
Quote in the paperSubstantial claim0 of 1 sources checked- cites ACOG, 2019
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- Premisecitation
Visual estimation increases the likelihood to underestimate blood loss when volumes are high.
“Visual estimation increases the likelihood to underestimate blood loss when volumes are high and to overestimate blood loss when volumes are low (ACOG, 2019).”
Quote in the paperSubstantial claim0 of 1 sources checked- cites ACOG, 2019
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- Premisecitation
Estimation of blood loss is less effective to detect excessive blood loss than automated quantification of blood loss.
“Estimation of blood loss is less effective to detect excessive blood loss than automated quantification of blood loss (QBL; Rubinstein et al., 2020).”
Quote in the paperSubstantial claim0 of 1 sources checked- cites Rubinstein et al., 2020
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- Premisecitation
Quantification of blood loss is an objective measurement.
“Quantification of blood loss is an objective measurement that is recommended for the early identification of hemorrhage for all births (ACOG, 2019; CMQCC, 2015, Main et al., 2015;Seacrist et al., 2019).”
Quote in the paperSubstantial claim0 of 3 sources checked- cites ACOG, 2019
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- cites CMQCC, 2015
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- cites Main et al., 2015 source
- Premisecitation
Delays in recognition and management result in costly treatment for women having postpartum hemorrhage.
“Delays in recognition and management result in costly treatment for women having postpartum hemorrhage (ACOG, 2019; California Maternal Quality Care Collaborative [CMQCC], 2015).”
Quote in the paperNot a substantial claim0 of 2 sources checked- cites ACOG, 2019
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- cites California Maternal Quality Care Collaborative [CMQCC], 2015
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- Premisecitation
Hemorrhage requiring blood transfusion remains the leading cause of maternal morbidity in the United States.
“Although maternal deaths from postpartum hemorrhage have decreased, hemorrhage requiring blood transfusion has increased and remains the leading cause of maternal morbidity in the United States (American College of Obstetricians and Gynecologists [ACOG], 2017).”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites American College of Obstetricians and Gynecologists [ACOG], 2017
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- Premisecitation
Limiting a standard process for measuring blood loss to only severe cases perpetuates delays in recognition and response.
“Limiting a standard process for measuring blood loss to only severe cases perpetuates delays in recognition and response (CMQCC, 2015).”
Quote in the paperSubstantial claim0 of 1 sources checked- cites CMQCC, 2015
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- Premisecitation
Hemorrhage requiring blood transfusion has increased in the United States.
“Although maternal deaths from postpartum hemorrhage have decreased, hemorrhage requiring blood transfusion has increased and remains the leading cause of maternal morbidity in the United States (American College of Obstetricians and Gynecologists [ACOG], 2017).”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites American College of Obstetricians and Gynecologists [ACOG], 2017
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- Premisecitation
Inaccurate evaluation of blood loss can lead to delays in response and management of postpartum hemorrhage.
“Inaccurate evaluation of blood loss can lead to delays in response and management of postpartum hemorrhage (Habak et al., 2016;Kahr et al., 2018).”
Quote in the paperSubstantial claim0 of 2 sources checked - Premisecitation
Quantification of blood loss offers a means by which the clinician can use objective measurement to support early response to and management of postpartum hemorrhage.
“Quantification of blood loss offers a means by which the clinician can use objective measurement to support early response to and management of postpartum hemorrhage (Dildy, 2018).”
Quote in the paperSubstantial claim0 of 1 sources checked- cites Dildy, 2018
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- Premisecitation
Improved outcomes have been reported when QBL was used as part of a standardized process in an obstetric hemorrhage bundle.
“Improved outcomes and reduction of cost have been reported when QBL was used as part of a standardized process in an obstetric hemorrhage bundle (ACOG, 2019, CMQCC, 2015;Katz, 2019).”
Quote in the paperSubstantial claim0 of 3 sources checked- cites ACOG, 2019
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- cites CMQCC, 2015
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- cites Katz, 2019 source
- Premisecitation
Quantification of blood loss provides more time for mobilization of additional resources.
“Quantification of blood loss promotes increased team awareness of patient emergencies, which provides more time for mobilization of additional resources (CMQCC, 2015;Katz et al., 2019)”
Quote in the paperSubstantial claim0 of 2 sources checked- cites CMQCC, 2015
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- cites Katz et al., 2019 source
- Premisecitation
Quantification of blood loss promotes increased team awareness of patient emergencies.
“Quantification of blood loss promotes increased team awareness of patient emergencies, which provides more time for mobilization of additional resources (CMQCC, 2015;Katz et al., 2019)”
Quote in the paperSubstantial claim0 of 2 sources checked- cites CMQCC, 2015
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- cites Katz et al., 2019 source
- Interpretationreasoning
More reliable clinical assessment of patient status leads to earlier detection of clinical deterioration.
“Objective measurement of blood loss promotes more reliable clinical assessment of patient status, which leads to earlier detection of clinical deterioration.”
Quote in the paperSubstantial claim - Premisecitation
Real-time completion of QBL may reduce the need for additional interventions, such as the administration of uterotonic medication.
“Real-time completion of QBL may reduce the need for additional interventions, such as the administration of uterotonic medication, which may lead to potential side effects, unnecessary procedures, and blood transfusions (Hire et al., 2020).”
Quote in the paperSubstantial claim0 of 1 sources checked- cites Hire et al., 2020 source
- Premisecitation
Reduction of cost has been reported when QBL was used as part of a standardized process in an obstetric hemorrhage bundle.
“Improved outcomes and reduction of cost have been reported when QBL was used as part of a standardized process in an obstetric hemorrhage bundle (ACOG, 2019, CMQCC, 2015;Katz, 2019).”
Quote in the paperNot a substantial claim0 of 3 sources checked- cites ACOG, 2019
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- cites CMQCC, 2015
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- cites Katz, 2019 source
- Premisecitation
Quantification of blood loss contributes to a reduction of blood transfusions.
“Quantification of blood loss contributes to earlier use of uterotonics when indicated and a reduction of blood transfusions, which lead to improved patient outcomes (Katz, et al., 2019)”
Quote in the paperSubstantial claim0 of 1 sources checked- cites Katz, et al., 2019 source
- Premisecitation
Quantification of blood loss contributes to earlier use of uterotonics when indicated.
“Quantification of blood loss contributes to earlier use of uterotonics when indicated and a reduction of blood transfusions, which lead to improved patient outcomes (Katz, et al., 2019)”
Quote in the paperSubstantial claim0 of 1 sources checked- cites Katz, et al., 2019 source
- Interpretationcitation
Objective measurement of blood loss promotes more reliable clinical assessment of patient status.
“Objective measurement of blood loss promotes more reliable clinical assessment of patient status, which leads to earlier detection of clinical deterioration.”
Quote in the paperSubstantial claim - Premisecitation
Reduction of blood transfusions leads to improved patient outcomes.
“Quantification of blood loss contributes to earlier use of uterotonics when indicated and a reduction of blood transfusions, which lead to improved patient outcomes (Katz, et al., 2019)”
Quote in the paperSubstantial claim0 of 1 sources checked- cites Katz, et al., 2019 source
- Premisecitation
Implementation of obstetric hemorrhage bundles that include QBL significantly reduces maternal morbidity.
“Implementation of obstetric hemorrhage bundles that include QBL have been found to significantly reduce maternal morbidity (ACOG, 2019).”
Quote in the paperSubstantial claim0 of 1 sources checked- cites ACOG, 2019
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- Classified as probably not a substantial claim. 3
- May combine two claims. 2
Probably not a substantial claim: may not pass S3 (load-bearing).
PremisecitationPostpartum hemorrhage remains a leading cause of maternal mortality in the United States.
“Postpartum hemorrhage remains a leading cause of maternal mortality in the United States.”
Quote in the paperNot a substantial claim0 of 2 sources checked- cites Centers for Disease Control and Prevention, 2021
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- cites Peterson et al., 2019
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
May combine two claims.
InterpretationcitationQBL can help to heighten clinician vigilance, enhance team awareness, and promote timely and strategic response to the clinical situation.
“Therefore, QBL can help to heighten clinician vigilance, enhance team awareness, and promote timely and strategic response to the clinical situation (Duzyj, 2020;Kodali, 2020;Ladouceur & Goldbort, 2019).”
Quote in the paperSubstantial claim0 of 3 sources checkedMay combine two claims.
PremisecitationQuantification of blood loss helps to increase the timely escalation of clinical care and can thus influence outcomes.
“Quantification of blood loss helps to increase the timely escalation of clinical care and can thus influence outcomes (Powell et al., 2020).”
Quote in the paperSubstantial claim0 of 1 sources checked- cites Powell et al., 2020
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
Classified as probably not a substantial claim.
PremisecitationQuantification of blood loss is a valuable tool for the appropriate surveillance and rescue of women who experience postpartum hemorrhage.
“Quantification of blood loss is a valuable tool for the appropriate surveillance and rescue of women who experience postpartum hemorrhage (Ladouceur & Goldbort, 2019).”
Quote in the paperSubstantial claim0 of 1 sources checked- cites Ladouceur & Goldbort, 2019 source
Classified as probably not a substantial claim.
PremisecitationNurses play a pivotal role in the development, implementation, and sustainment of QBL protocols.
“Nurses play a pivotal role in the development, implementation, and sustainment of QBL protocols (Ladouceur & Goldbort, 2019).”
Quote in the paperSubstantial claim0 of 1 sources checked- cites Ladouceur & Goldbort, 2019 source
The paper relies on this without support.
The process of QBL is nurse-led, within the scope of practice of the registered nurse, and does not require a provider order or signature.
“The process of QBL is nurse-led, within the scope of practice of the registered nurse, and does not require a provider order or signature.”
Cites
Practice Bulletin No. 183: postpartum hemorrhage
(2017) · Obstetrics & Gynecology · doi:10.1097/aog.0000000000002351 · Cited by 1,406 · see citing works
Shields, L. E., Wiesner, S., Fulton, J., & Pelletreau, B. (2015) · American Journal of Obstetrics and Gynecology · doi:10.1016/j.ajog.2014.07.012 · Cited by 276 · see citing works
Al Kadri, H. M. F., Al Anazi, B. K., & Tamim, H. M. (2011) · Archives of Gynecology and Obstetrics · doi:10.1007/s00404-010-1522-1 · Cited by 199 · see citing works
Quantitative Blood Loss in Obstetric Hemorrhage
(2019) · Obstetrics and Gynecology · doi:10.1097/aog.0000000000003564 · Cited by 194 · see citing works
Precise estimation of postpartum haemorrhage: Difficulties and importance
Brant, H. A. (1967) · BMJ · doi:10.1136/bmj.1.5537.398 · Cited by 109 · see citing works
Accuracy of Blood Loss Measurement during Cesarean Delivery
Doctorvaladan, S., Jelks, A., Hsieh, E., Thurer, R., Zakowski, M., & Lagrew, D. (2017) · American Journal of Perinatology Reports · doi:10.1055/s-0037-1601382 · Cited by 65 · see citing works
National Partnership for Maternal Safety: Consensus bundle on obstetric hemorrhage
Main, E. K., Goffman, D., Scavone, B. M., Low, L. K., Bingham, D., Fontaine, P. L., Gorlin, J. B., Lagrew, D. C., & Levy, B. S. (2015) · Journal of Obstetric, Gynecologic & Neonatal Nursing · doi:10.1111/1552-6909.12723 · Cited by 58 · see citing works
Validation of a quantitative system for real-time measurement of postpartum blood loss
Kahr, M. K., Brun, R., Zimmermann, R., Franke, D., & Haslinger, C. (2018) · Archives of Gynecology and Obstetrics · doi:10.1007/s00404-018-4896-0 · Cited by 55 · see citing works
Katz, D., Wang, R., O'Neil, L., Gerber, C., Lankford, A., Rogers, T., Gal, J., Sandler, R., & Beilin, Y. (2020) · International Journal of Obstetric Anesthesia · doi:10.1016/j.ijoa.2019.05.006 · Cited by 49 · see citing works
Seacrist, M. J., VanOtterloo, L. R., Morton, C. H., et al. (2019) · Journal of Obstetric, Gynecologic & Neonatal Nursing · doi:10.1016/j.jogn.2019.03.002 · Cited by 30 · see citing works
Powell, E., James, D., Collis, R., Collins, P. W., Pallmann, P., & Bell, S. (2022) · The Journal of Maternal-Fetal & Neonatal Medicine · doi:10.1080/14767058.2020.1759534 · Cited by 26 · see citing works
Automated Quantification of Blood Loss versus Visual Estimation in 274 Vaginal Deliveries
Rubenstein, A. F., Zamudio, S., Douglas, C., Sledge, S., & Thurer, R. L. (2020) · American Journal of Perinatology · doi:10.1055/s-0040-1701507 · Cited by 25 · see citing works
Hire, M. G., Lange, E. M. S., Vaidyanathan, M., Armour, K. L., & Toledo, P. (2020) · Journal of Obstetric, Gynecologic & Neonatal Nursing · doi:10.1016/j.jogn.2020.01.002 · Cited by 22 · see citing works
Seacrist, M. J., Morton, C. H., VanOtterloo, L. R., & Main, E. K. (2019) · Journal of Obstetric, Gynecologic & Neonatal Nursing · doi:10.1016/j.jogn.2019.02.007 · Cited by 18 · see citing works
A proactive approach to quantification of blood loss in the perinatal setting
Ladouceur, M. K., & Goldbort, J. (2019) · Nursing for Women's Health · doi:10.1016/j.nwh.2019.09.007 · Cited by 10 · see citing works
Duzyj, C. M., Boyle, C. D., Mahoney, K. M., et al. (2020) · American Journal of Perinatology · doi:10.1055/s-0040-1712452 · Cited by 10 · see citing works
A comparison of visual estimate versus calculated estimate of blood loss at vaginal delivery
Habak, P., Patters, K., Abeyta, A., Gonzalez, C., Keita, M., Drachman, D., & Coonrod, D. (2016) · British Journal of Medicine and Medical Research · doi:10.9734/bjmmr/2016/19239 · Cited by 7 · see citing works
Kodali, B. S. (2020) · Anesthesia & Analgesia · doi:10.1213/ane.0000000000005026 · Cited by 3 · see citing works
Flagged first, then by citations
2 of the 20 references couldn’t be matched to a known paper.
Research works printed but not linked: 2
- Dildy, 2018, How to prepare for postpartum hemorrhage: Lapses in safety culture play a significant role in maternal mortality, Contemporary OB/GYN, 63, 22
- Peterson, 2019, Vital signs: Pregnancy-related deaths, United States, 2011-1015, and strategies for prevention, 13 states, 2013-2017, Morbidity and Mortality Weekly Report, 68, 423
Cited by
Sorted by citations
Peng, C., Acharya, M., Khattab, B., et al. (2025) · BMC Pregnancy and Childbirth · doi:10.1186/s12884-025-07896-3 · Cited by 9 · see citing works
“Given the importance of quantification for accurate assessment of blood loss, [31, 32] local tests of change with approaches that simplify and reduce staff burden for quantitative assessment, [33] such as automatic calculations in the electronic medical record, may improve local adoption of this…”
Evaluation During Postpartum Hemorrhage
Türkoğlu, O., & Friedman, P. (2023) · Clinical Obstetrics & Gynecology · doi:10.1097/grf.0000000000000784 · Cited by 9 · see citing works
Lavoie, P., Lapierre, A., Maheu‐Cadotte, M., Rodriguez, D., Lavallée, A., & Mailhot, T. (2022) · Nurse Education Today · doi:10.1016/j.nedt.2022.105361 · Cited by 10 · see citing works
“In obstetrics, students, nurses, and midwives tend to underestimate postpartum blood loss, which can pose a serious threat to patient safety (Association of Women’s Health, 2021; Leduc et al., 2018; Parayre et al., 2015).”
Ruiz, M. T., Azevedo, N. F., de Resende, C. V., Rodrigues, W. F., Meneguci, J., Contim, D., Wernet, M., & Oliveira, C. J. F. (2023) · Revista Brasileira de Enfermagem · doi:10.1590/0034-7167-2023-0070 · Cited by 8 · see citing works
“These data are corroborated by results found in other studies in which the use of simulation in cases of PPH was investigated (36,46,49-50) .”
BackgroundMethodResultOptimizing systems to manage postpartum hemorrhage
Dulaney, B. M., Elkhateb, R., & Mhyre, J. M. (2022) · Best practice & research. Clinical anaesthesiology · doi:10.1016/j.bpa.2022.10.001 · Cited by 5 · see citing works
Ruiz, M. T., Azevedo, N. F., de Resende, C. V., Rodrigues, W. F., Meneguci, J., Contim, D., Wernet, M., & Oliveira, C. J. F. (2023) · Revista Brasileira de Enfermagem · doi:10.1590/0034-7167-2023-0070pt · Cited by 4 · see citing works
(2021) · Journal of Obstetric, Gynecologic & Neonatal Nursing · doi:10.1016/j.jogn.2021.04.006 · Cited by 5 · see citing works
Tranexamic acid as adjuvant treatment for postpartum hemorrhage: a systematic review protocol
Fahrenholtz, C. G., Bonanno, L. S., & Martin, J. B. (2019) · The JBI Database of Systematic Reviews and Implementation Reports · doi:10.11124/jbisrir-2017-003978 · Cited by 4 · see citing works
Association of Women’s Health, O. A. N. N. (2021) · Nursing for Women s Health · doi:10.1016/j.nwh.2021.04.004 · Cited by 3 · see citing works
Time to Hemorrhage Response after Implementation of Obstetric Hemorrhage Bundle
Srivastava, A., Wang, M. J., Young, S., et al. (2025) · American Journal of Perinatology · doi:10.1055/a-2559-1837 · Cited by 2 · see citing works
Singh, G., Singh, V. A., Sasidharan, S., et al. (2020) · Journal of Obstetrics and Gynecological Investigations · doi:10.5114/jogi.2020.102418 · Cited by 2 · see citing works
Quantitative Blood Loss Implementation in Cesarean Births
Hendrixson, A., Quinn, C. M., & Haughton, V. (2022) · AORN Journal · doi:10.1002/aorn.13788 · Cited by 1 · see citing works
Kükrer, S., & KÜKRER, A. P. (2021) · Journal of Turkish Society of Obstetric and Gynecology · doi:10.4274/tjod.galenos.2021.05873 · Cited by 1 · see citing works
Dayal, A. K., Skupski, D. W., Chan-Akeley, R., et al. (2025) · International Journal of Gynecology & Obstetrics · doi:10.1002/ijgo.70541
“The validated hemorrhage risk assessment protocol, adapted from the Association of Women's Health, Obstetric, and Neonatal Nurses (AWHONN), 4,22 is shown in Table 1 .”
Kamel, H. A.-D. H., Mohammed, M. M., & Dawood, A. O. I. (2024) · Al-Azhar International Medical Journal /Al-Azhar International Medical Journal · doi:10.58675/2682-339x.2369
Patil, P., Mishra, N. K., Batni, S., et al. (2024) · Journal of Clinical Obstetrics & Gynecology · doi:10.5336/jcog.2023-98601
Fatherree, D. L., & Palokas, M. J. (2023) · International Journal of Evidence-Based Healthcare · doi:10.1097/xeb.0000000000000395
- Venue
- Journal of Obstetric, Gynecologic & Neonatal Nursing
- Publisher
- Elsevier BV
- Published
- 2021-07
- Volume
- 50
- Issue
- 4
- Pages
- 503-505
- ISSN
- 0090-0311 (ISSN-L)
- 0884-2175
- OpenAlex
- W3175722016
- Semantic Scholar
- f2875fece84b3de99c321593b648269fa04fe5e5
- Cited by
- 18
- References
- 20
- Citations by year
- 2026: 1 · 2025: 3 · 2024: 2 · 2023: 4 · 2022: 3 · 2021: 3 · 2020: 1 · 2019: 1
- FWCI
- 2.96
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Journal of Obstetric, Gynecologic & Neonatal Nursing (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Association of Women's Health, Obstetric and Neonatal Nurses
- Topics
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Maternal and fetal healthcare
- Health Sciences › Medicine › Obstetrics and Gynecology › Maternal and Perinatal Health Interventions
- Health Sciences › Medicine › Biochemistry › Blood transfusion and management
- Keywords
- postpartum hemorrhage, obstetric hemorrhage, blood loss measurement, clinical deterioration detection, patient safety, vaginal delivery, obstetric nursing, ACOG committee opinion, obstetric quality improvement
- MeSH terms
- Hemorrhage, Humans
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