Incidence and Pregnancy Outcomes of Primary Postpartum Hemorrhage Following Implementation of Postpartum Drape with a Calibrated Bag after Normal Vaginal Delivery

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Jarunee Leetheeragul
Ratree Sirisomboon
Kanjana Pimol
Tripop Lertbunnaphong
Pattarawan Limsiri


Objective: To evaluate the incidence, risk factors, and pregnancy outcomes of primary postpartum hemorrhage (PPH) after the implementation of postpartum drape with a calibrated bag (PDCB) after normal vaginal delivery.
Methods: This retrospective chart review compared patients who had normal vaginal delivery in June 2012 prior to PDCB implementation with patients who had normal vaginal delivery in June 2014 after PDCB implementation at Siriraj Hospital.
Results: In total, 856 patients were included in this study, with 458 and 398 patients delivered in June 2012 and June 2014, respectively. Baseline characteristics were comparable between the two groups. The incidence of primary PPH increased significantly after the implementation of PDCB (2.8% in 2012 vs. 8.5% in 2014; p < 0.01). The incidence of severe PPH was also significantly increased (0.4% in 2012 vs. 2.3% in 2014; p = 0.02). Uterine atony was the most common cause and the diagnosis increased after PCDB implementation. The use of additional uterotonic drugs was also significantly increased after PDCB implementation (30.8% in 2012 vs. 85.3% in 2014; p < 0.01). The blood transfusion rate was comparable between the two groups. No peripartum hysterectomy or ICU admission was observed in this study. After PDCB implementation, pregnancy-induced hypertension was found to be a significant risk factor for primary PPH (p < 0.01).
Conclusion: The incidence of primary and severe PPH, and the rate of the use of additional uterotonic drugs were all significantly increased after the implementation of PDCB. Pregnancy-induced hypertension was found to be a significant risk factor for primary PPH.


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How to Cite
Leetheeragul, J. ., Sirisomboon, R., Pimol , K. ., Lertbunnaphong, T. ., & Limsiri, P. . (2020). Incidence and Pregnancy Outcomes of Primary Postpartum Hemorrhage Following Implementation of Postpartum Drape with a Calibrated Bag after Normal Vaginal Delivery. Siriraj Medical Journal, 72(3), 219–225.
Original Article


1. WHO Recommendations for the Prevention and Treatment of Postpartum Haemorrhage. WHO Guidelines Approved by the Guidelines Review Committee. Geneva, 2012.
2. Say L, Chou D, Gemmill A, Tuncalp O, Moller AB, Daniels J, et al. Global causes of maternal death: a WHO systematic analysis. Lancet Glob Health 2014;2:e323-33.
3. Khan R-U, El-Refaey H. Pathophysiology of Postpartum Hemorrhage and Third Stage of Labor: An Essential Clinical Reference for Effective Management. In: Arulkumaran S, Karoshi M, Keith LG, Lalonde AB, B-Lynch C, editors. A Comprehensive Textbook of Postpartum Hemorrhage. 2nd ed. London: Sapiens Publishing; 2012. p. 94-100.
4. Lalonde A, International Federation of Gynecology and Obstetrics. Prevention and treatment of postpartum hemorrhage in low-resource settings. Int J Gynaecol Obstet 2012;117:108-18.
5. Schorn MN. Measurement of blood loss: review of the literature. J Midwifery Womens Health 2010;55:20-7.
6. Patel A, Goudar SS, Geller SE, Kodkany BS, Edlavitch SA, Wagh K, et al. Drape estimation vs. visual assessment for estimating postpartum hemorrhage. Int J Gynaecol Obstet 2006;93:220-4.
7. Razvi K, Chua S, Arulkumaran S, Ratnam SS. A comparison between visual estimation and laboratory determination of blood loss during the third stage of labour. Aust N Z J Obstet Gynaecol 1996;36:152-4.
8. Al Kadri HM, Al Anazi BK, Tamim HM. Visual estimation versus gravimetric measurement of postpartum blood loss: a prospective cohort study. Arch Gynecol Obstet 2011;283:1207-13.
9. Lertbunnaphong T, Lapthanapat N, Leetheeragul J, Hakularb P, Ownon A. Postpartum blood loss: visual estimation versus objective quantification with a novel birthing drape. Singapore Med J 2016;57:325-8.
10. Ambardekar S, Shochet T, Bracken H, Coyaji K, Winikoff B. Calibrated delivery drape versus indirect gravimetric technique for the measurement of blood loss after delivery: a randomized trial. BMC Pregnancy Childbirth 2014;14:276.
11. Prasertcharoensuk W, Swadpanich U, Lumbiganon P. Accuracy of the blood loss estimation in the third stage of labor. Int J Gynaecol Obstet 2000;71:69-70.
12. Bamberg C, Niepraschk-von Dollen K, Mickley L, Henkelmann A, Hinkson L, Kaufner L, et al. Evaluation of measured postpartum blood loss after vaginal delivery using a collector bag in relation to postpartum hemorrhage management strategies: a prospective observational study. J Perinat Med 2016;44:433-9.
13. Prevention and Management of Postpartum Haemorrhage: Green-top Guideline No. 52. BJOG 2017;124:e106-e149.
14. Abbaspoor Z, Vaziri L. The Effectiveness of a Collector Bag for Measurement of Post-partum Hemorrhage. Afr J Reprod Health 2017;21:99-103.
15. Vallera C, Choi LO, Cha CM, Hong RW. Uterotonic Medications: Oxytocin, Methylergonovine, Carboprost, Misoprostol. Anesthesiol Clin 2017;35:207-19.
16. Postpartum hemorrhage. Practice Bulletin No. 183. American College of Obstetricians and Gynecologists. Obstet Gynecol 2017;130:e168-86.
17. Sebghati M, Chandraharan E. An update on the risk factors for and management of obstetric haemorrhage. Womens Health (Lond) 2017;13:34-40.
18. Wetta LA, Szychowski JM, Seals S, Mancuso MS, Biggio JR, Tita AT. Risk factors for uterine atony/postpartum hemorrhage requiring treatment after vaginal delivery. Am J Obstet Gynecol 2013;209:51.e1-6.

19. Witlin AG, Friedman SA, Sibai BM. The effect of magnesium sulfate therapy on the duration of labor in women with mild preeclampsia at term: a randomized, double-blind, placebo-controlled trial. Am J Obstet Gynecol 1997;176:623-7.
20. Lertbunnaphong T, Leetheeragul J, Thitadilok W. Risk Factors of Primary Postpartum Hemorrhage in Siriraj Hospital. Siriraj Med J 2010;62:195-8.
21. Zhang WH, Deneux-Tharaux C, Brocklehurst P, Juszczak E, Joslin M, Alexander S, et al. Effect of a collector bag for measurement of postpartum blood loss after vaginal delivery: cluster randomised trial in 13 European countries. BMJ 2010;340:c293.
22. Hancock A, Weeks AD, Lavender DT. Is accurate and reliable blood loss estimation the 'crucial step' in early detection of postpartum haemorrhage: an integrative review of the literature. BMC Pregnancy Childbirth 2015;15:230.

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