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Learning Objective #1: describe the inaccuracies associated with quantitative estimations of postpartum blood loss.

Learning Objective #2: summarize the evidence associated with the estimation of postpartum blood loss by women in Matlab, Bangladesh.

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Worldwide, 529, 999 women die each year from complications of pregnancy and childbirth, with 99% of deaths taking place in developing countries. Postpartum hemorrhage is the most common cause of maternal mortality worldwide. Recognition and response to postpartum hemorrhage is critical because of the short interval between onset of bleeding and death. Recognition depends on an assessment or estimation of blood loss. However, estimates of postpartum blood loss, calculated by subjective visual quantification, are known to be fraught with error in clinical settings. Little is known about the estimation of postpartum blood loss by lay women in developing countries where half of women continue to give birth at home assisted by unskilled providers. In this study, an analysis was performed using recent data obtained from a larger study in Matlab, Bangladesh on the recognition of and response to postpartum hemorrhage. We specifically focused our analysis on data from six questions involving blood loss and blood collection devices employed immediately after delivery and within the first twenty-four hours of delivery. The objectives of the analyses were: 1) to describe the methods by which women estimate blood loss, 2) to compare these estimates to actual biomedical standards and, 3) to determine differences in estimates of women who had or had not recently been involved in a perceived postpartum hemorrhage event. The results from this study suggest estimates of postpartum blood loss are unreliable and exceed current biomedical standards. Our findings suggest problems with the current gold-standard method of defining and diagnosing postpartum hemorrhage Further research on the lay estimation of postpartum blood loss in developing countries is warranted.