A Comparison of Excessive Postpartum Blood Loss Estimates Among Three Subgroups of Women Attending Births in Matlab, Bangladesh

Introduction: Postpartum hemorrhage (PPH) is the leading cause of maternal death and disability worldwide. The recognition of PPH depends on subjective visual quantification. This study sought to assess and compare the thresholds for excessive postpartum blood loss reported by skilled birth attendants (SBAs), traditional birth attendants (TBAs), and laywomen in Matlab, Bangladesh. Methods: Data from six questions asking about excessive blood loss in the postpartum period were analyzed using analysis of variance, the Hochberg test, the Kruskal-Wallis test, and standard descriptive statistics. Results: We found that the thresholds for excessive blood loss estimated by laywomen and TBAs exceed the biomedical standards for PPH. Skilled birth attendant reports are consistent with the definition of severe acute PPH. Discussion: Further research on locally validated blood collection devices, in birth kits, for diagnostic aid or referral indication is needed. Areas where the coverage and uptake of skilled birth attendance are low should be targeted because of the number of homebirths attended by TBAs and laywomen in such settings.