{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T07:49:43Z","timestamp":1791532183866,"version":"4.3.4"},"reference-count":19,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T00:00:00Z","timestamp":1787875200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T00:00:00Z","timestamp":1787875200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pregnancy"],"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To compare the performance of quantitative blood loss (QBL) to graduated estimated blood loss (EBL) for prediction of clinical outcomes in spontaneous vaginal deliveries (SVDs).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Prospective observational study including SVDs with a recorded QBL at a single institution. QBL was calculated and recorded in the electronic medical record by the nurse following delivery with the providers pragmatically blinded to these calculations. Providers used clinical indices and a graduated EBL, assigned prior to QBL calculation, to diagnose postpartum hemorrhage (PPH) with a specific postpartum acuity\u2010based observation process for patients with PPH. PPH was defined as blood loss\u00a0&gt;500 cc. EBL and QBL were directly compared for the purposes of this investigation. Performance characteristics were calculated for EBL and QBL with regard to detection of transfusion and decrease in hematocrit greater than 10% (\u0394Hct \u2265 10) from the day of delivery to postpartum day one. Patients with discrepancies between QBL and EBL were examined with odds ratios of transfusion and \u0394Hct \u2265 10 calculated.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>There were a total of 8107 SVDs. Rates of PPH were higher when defined by QBL (17% vs. 9%), with a 2.5% rate of transfusion. A discrepancy\u00a0&gt;500 cc between QBL and EBL was found in 226 (3%) patients. PPH as defined by EBL demonstrated lower sensitivity but higher specificity, PPV, and NPV for transfusion and higher specificity and PPV for \u0394Hct \u2265 10. When examining deliveries with EBL \u2264 500 cc but QBL \u2265 500 cc, odds of transfusion (odds ratio [OR], 1.41; 95% confidence interval [CI], 1.02\u20131.93) and \u0394Hct \u2265 10 (OR, 2.94; 95% CI, 2.39\u20133.59) were increased. Conversely, this was true in cases of EBL \u2265 500 cc with a QBL \u2264 500 cc, with an odds of transfusion (OR, 6.38; 95% CI, 4.43\u20139.01) and \u0394Hct \u2265 10 of 3.41 (95% CI, 2.41\u20134.47). For every 2700 deliveries in which QBL was used to guide care, one additional transfusion would be identified versus using EBL alone.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Graduated EBL demonstrates higher specificity for transfusion and \u0394Hct \u2265 10 when compared to QBL. In an environment with a standardized graduated EBL and an acuity\u2010based postpartum observation process, QBL does not offer additional benefits after SVD. In places with limited resources, graduated EBL is a good alternative to QBL.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/pmf2.70385","type":"journal-article","created":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T13:44:50Z","timestamp":1787924690000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Performance of quantitative and graduated estimated blood loss in detection of postpartum hemorrhage after spontaneous vaginal delivery"],"prefix":"10.1002","volume":"2","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8283-9632","authenticated-orcid":false,"given":"Alesha","family":"White","sequence":"first","affiliation":[{"name":"Department of Obstetrics &amp; Gynecology University of Texas Southwestern Medical Center  Dallas Texas USA"},{"name":"Department of Obstetrics &amp; Gynecology Parkland Health Dallas Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9703-763X","authenticated-orcid":false,"given":"R. Nicholas","family":"Burns","sequence":"additional","affiliation":[{"name":"Department of Obstetrics &amp; Gynecology University of Texas Southwestern Medical Center  Dallas Texas USA"},{"name":"Department of Obstetrics &amp; Gynecology Parkland Health Dallas Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9019-3229","authenticated-orcid":false,"given":"Jessica E.","family":"Pruszynski","sequence":"additional","affiliation":[{"name":"Department of Obstetrics &amp; Gynecology University of Texas Southwestern Medical Center  Dallas Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Deepa","family":"Ravindra","sequence":"additional","affiliation":[{"name":"Department of Obstetrics &amp; Gynecology University of Texas Southwestern Medical Center  Dallas Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4990-146X","authenticated-orcid":false,"given":"Tiffany","family":"Montgomery","sequence":"additional","affiliation":[{"name":"Department of Obstetrics &amp; Gynecology Parkland Health Dallas Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kristina X.","family":"Fin","sequence":"additional","affiliation":[{"name":"Department of Obstetrics &amp; Gynecology University of Texas Southwestern Medical Center  Dallas Texas USA"},{"name":"Department of Obstetrics &amp; Gynecology Parkland Health Dallas Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8539-703X","authenticated-orcid":false,"given":"Brenda","family":"Anyaehie","sequence":"additional","affiliation":[{"name":"Department of Obstetrics &amp; Gynecology University of Texas Southwestern Medical Center  Dallas Texas USA"},{"name":"Department of Obstetrics &amp; Gynecology Parkland Health Dallas Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elaine L.","family":"Duryea","sequence":"additional","affiliation":[{"name":"Department of Obstetrics &amp; Gynecology University of Texas Southwestern Medical Center  Dallas Texas USA"},{"name":"Department of Obstetrics &amp; Gynecology Parkland Health Dallas Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,8,28]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1097\/00006250\u2010200610000\u201000046"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.15585\/mmwr.mm6818e1"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1055\/s\u20100031\u20101280856"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.AOG.0000187894.71913.e8"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1097\/aog.0000000000002851"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.7759\/cureus.13591"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1055\/s\u20100037\u20101613675"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00404\u2010010\u20101522\u20101"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.1055\/s\u20100039\u20101688823"},{"key":"e_1_2_8_11_1","doi-asserted-by":"publisher","DOI":"10.1080\/00016340600985032"},{"key":"e_1_2_8_12_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12884\u2010015\u20100653\u20106"},{"key":"e_1_2_8_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijgo.2006.02.014"},{"key":"e_1_2_8_14_1","doi-asserted-by":"publisher","DOI":"10.1186\/1471\u20102393\u201014\u2010276"},{"key":"e_1_2_8_15_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.c293"},{"key":"e_1_2_8_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2019.06.022"},{"key":"e_1_2_8_17_1","doi-asserted-by":"publisher","DOI":"10.1055\/s\u20100037\u20101606275"},{"key":"e_1_2_8_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/0002\u20109378(60)90474\u20109"},{"key":"e_1_2_8_19_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jogn.2020.09.029"},{"key":"e_1_2_8_20_1","unstructured":"R Core Team.2024.R: Language and Environment for Statistical Computing. 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