Development of a Simple Decision-Making Tool to Accurately Assess Excessive Blood Loss and Postpartum Hemorrhage at Childbirth

Obstetric hemorrhage is estimated to cause 25% of maternal deaths and is the leading direct cause of maternal mortality worldwide. Postpartum hemorrhage (PPH), characterized as severe bleeding in excess of 500 ml after the birth of a baby, accounts for the majority of hemorrhage cases and occurs in over 10% of births, with a 1% case-fatality rate. Maternal anemia, which affects up to half of all women globally, has long been purported as an underlying risk factor for PPH, and this assertion has been recently supported by evidence in Africa. A significant challenge to detecting the amount of blood lost at childbirth is that health workers routinely rely on visual estimation as the standard of care for deciding whether the amount of blood a woman loses at childbirth - including excessive losses and PPH -merits immediate treatment or referral to the nearest hospital/health facility. We aim to develop a simple low-cost decision-making tool to accurately assess the amount of blood lost, in relation to anemia, based on the gold standard for blood loss measurement, while taking into account health workers' visual estimations. This two-sided laminated paper tool will help health workers identify women who require referral and/or treatment for excessive blood loss and PPH. Strategies that accurately and promptly diagnose PPH as well as maternal anemia are especially valuable in contexts where anemia prevalence is high, and can go far toward improving decision-making for referral and treatment, as reducing maternal morbidity and mortality.