Blood Loss Measurement During Cesarean Delivery
Condition: Pregnancy
MeSH terms: Hemorrhage
Study type: Observational

Summary: 
      The aim of this study is to assess the ability of the Triton Device to measure blood loss
      among women undergoing elective and non-elective cesarean delivery. This patient population
      often experiences significant blood loss during surgery, and measurements of surgical blood
      loss are often inaccurate.
    

Detailed description: 
      This is an observational study. Potential participants will be approached by a member of the
      research team prior to surgery. Healthy ASA 1, 2, or 3 patients undergoing uncomplicated
      Cesarean delivery will be recruited. The Triton device will be used during the surgery to
      estimate blood loss. Specifically, the device takes pictures of the blood saturated laps and
      fluid collection canister and calculates hemoglobin loss and overall blood loss.

      Serum hemoglobin samples will be collected at baseline on presentation to the pre-operative
      area, within 15 mins of arrival in PACU and at 24 hrs post cesarean delivery. Blood sampling
      will take place by venipuncture technique from a vein in the arm. Maternal vital signs during
      the perioperative period (heart rate, maternal mean arterial blood pressure, anesthetic
      technique, fluid administration, and surgical data will be recorded.

      All patient will have a neuraxial anesthetic of a spinal or combined spinal/epidural. Fluid
      administration will be under the discretion of the anesthesiologist and will follow standard
      guidelines including 1L of Lactated Ringers co-load at time of spinal and 1-2L of crystaloid
      intraoperatively.

      At the end of the cesarean section, the following measurements will be made:

        1. tEBL: Triton device will be used to measure blood loss on wet and dry soaked laps and in
           the suction canister. These measurements will be used to calculate tEBL.

        2. vEBL: The attending obstetrician and anesthesiologist will independently be asked to
           provide estimates for total blood loss (vEBL). We will use both values in separate
           regression analyses

        3. qEBL: Blood loss will be measured by cumulative measurement of the following: the volume
           of blood in the suction chamber at the end of surgery (and subtracting the estimated
           amniotic fluid from the suction chamber; weight of blood soaked laps; estimated spillage
           of blood (in ml) in and around the surgical field (not collected on laps or in suction
           chamber).

      Using mixed effects modeling, we will determine whether estimated blood loss measurements
      using Triton (tEBL) can be used to predict postpartum hemoglobin (Hb) levels, after
      accounting for the predelivery Hb level, intraoperative intravenous fluids and
      patient/operative factors.
    

Observational model: Cohort
Time perspective: Prospective
Sampling method: Non-Probability Sample
Study population: 
        Healthy female patients undergoing uncomplicated Cesarean delivery
      
Keywords: Cesarean; Blood Loss; Triton