Use of a visual aid to improve estimation of blood loss in obstetrics

Nokubonga Makhubo, Jennifer Dianne Makin, Sumaiya Adam



Post- partum haemorrhage (PPH) remains one of the most significant causes of maternal morbidity.  In South Africa it is the second leading cause of maternal death. Education programmes, such as a visual aid, can improve the estimation of blood loss and subsequently improve clinical judgement and intervention.


The aim of our study was to assess if there would be any improvement in blood loss estimation after the introduction of a visual aid.


We conducted an intervention study at University of Pretoria Academic Complex and included the Departments of Obstetrics and Gynaecology and Anaesthesiology. The visual–aid which was created using surgical materials and expired blood from the South African National Blood Services.  A pre-intervention OSCE was conducted with various blood volumes. Thereafter, the visual aid was made available to all study participants. Nine months later a second OSCE was conducted.


Eighty two participants were recruited and 21 were lost to follow -up.  Sixty one participants were included in the analysis. The overall score from the initial OSCE (4.7500) improved to 5.6393 on the second OSCE (p = 0.003). Participants tended to move from under-estimation to either over-estimation or accurate estimation of blood loss. The consultant group of paticipants were the most accurate in estimating blood loss (p = 0.450).


The use of a visual aid can improve the estimation of blood loss by healthcare professionals, thus potentially improving resuscitation, and impacting positively on maternal morbidity and mortality associated with post -partum haemorrhage

Authors' affiliations

Nokubonga Makhubo, University of Pretoria

Jennifer Dianne Makin, University of Pretoria Medical Research Unit for Maternal and Infant Health Care Strategies

Sumaiya Adam, University of Pretoria

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Blood loss, postpartum haemorrhage, visual aid

Cite this article

South African Journal of Obstetrics and Gynaecology 2018;24(1):18-21. DOI:10.7196/sajog.1282

Article History

Date submitted: 2017-11-23
Date published: 2018-05-18

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