Do your OBs underestimate EBLs?

Specialties Ob/Gyn

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I think some of ours do, although I can't prove it.

The other night when I had a PPH r/t retained frags, they came in & did a manual removal (mentioned in another thread -- no pain meds :angryfire ). After all was said and done (and blood was everywhere), the EBL (of the PPH) was 300ml. Uh, I don't think so.

Not when a wad of clots almost the size of a volleyball comes out -- not including what we'd already expressed before they got there.

I should've weighed the chux to see how much blood there was. 300ml my big toe. :uhoh3:

Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.

Nope not as a rule. They are quite honest, thankfully. And our apgar scoring is truthful. I don't see why people need to lie; in the end, it could really BITE.

A bit OT: we have an NNP who does not believe in apgars of 10, period. She says it's impossible. I disagree. I have seen a few (yes very few) kids with pink all they way to their last nail bed and if I see a 10, I score a 10; she can dispute it all day til the cows come home. I chart what I see.

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Specializes in L&D all the way baby!.

I've had two 10/10's and they WERE 10's. Beautiful and pink to the toes! :redpinkhe

We have a doc that gives EBL's like this "uh the EBL was let me think .. about 214" or "666" if he's being really ornery. Monday, Wednesday, Friday get odd numbers the other days get evens. I wonder what people think when they do chart review... did he pull out the graduated cylinder?

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Specializes in OB, lactation.

I almost gave my baby on Wednesday 10/10 and he was a c/s too... came out screaming bloody murder and pink pink (LOVE it!!) but just tiniest bit lighter on hands/feet so I let 9/9 stand...

We only have pedi's at unplanned c/s (and they don't make it to those alot of the time) so we do 95% (probably more than that actually) of our APGARs.

I'm not sure on the EBL... I'm tending to think ours are pretty honest although we don't have many >500EBL.

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The nurses do the apgars where I work.

I haven't noticed underestimating blood loss.

Clots the size of a volleyball though !!!! ???? :confused::uhoh3::smackingf:no: Wow.

steph

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Specializes in nursery, L and D.

I think our docs all put 300ml on a SVD and 500ml on a c/s. Unless it was waaayyy out of normal these are their "numbers". I have given several 9/10 and a couple of 10/10 APGARS. The OB docs will really get mad if you give them under an 8. They will try to tell you they are an 8 if they aren't breathing, are blue, and HR is 40. I finally asked about this and one of the OBs said this is their "report card" or how well they did during the labor and delivery. I have learned not to announce APGARS to the L and D nurse until the doc is out of the room.

I read an article a few months ago that said the delivering doc shouldn't do APGARs at all, ever, because of the trend of scoring them to high. I wonder if the same should be said of the EBL?

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Specializes in Diabetes ED, (CDE), CCU, Pulmonary/HIV.
I was in a workshop on management of PPH and they said that nurses tend to overestimate and docs to underestimate. I wish I could remember the source for it but I can't find it, sorry.

On the lighter side--i;ve heard it's twice what the doc estimates and half of what the nurse estimates!

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Specializes in nursery, L and D.
On the lighter side--i;ve heard it's twice what the doc estimates and half of what the nurse estimates!

Sorta like an alcoholics intake:lol2:

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Specializes in L&D all the way baby!.

Along those lines do you have docs who look at the board, see a pt. is say 7 cm go in and examine her and say she is 5? We did a little test. Whatever the pt. was we subtracted one or two (if she was 7 we'd say 5) of course he'd come out and say "she's 7 you know!" He just wanted to contradict... didn't matter if he was right he just wanted you to be wrong. Egomaniac

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Along those lines do you have docs who look at the board, see a pt. is say 7 cm go in and examine her and say she is 5? We did a little test. Whatever the pt. was we subtracted one or two (if she was 7 we'd say 5) of course he'd come out and say "she's 7 you know!" He just wanted to contradict... didn't matter if he was right he just wanted you to be wrong. Egomaniac

What I find is the docs want to tell the women that they are more dilated so as not to disappoint them. So, they check and say "oh, 3 cm" and I check and think "oh, fingertip". ;)

It is not ego for these guys - they just don't want to give "bad" news.

steph

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Specializes in postpartum, nursery, high risk L&D.
Along those lines do you have docs who look at the board, see a pt. is say 7 cm go in and examine her and say she is 5? We did a little test. Whatever the pt. was we subtracted one or two (if she was 7 we'd say 5) of course he'd come out and say "she's 7 you know!" He just wanted to contradict... didn't matter if he was right he just wanted you to be wrong. Egomaniac

ooo, we have a guy like that. he always goes higher or lower than what the nurse says, depending on his mood or his "agenda" :angryfire

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